Efficacy of perioperative stepwise combined enteral and parenteral nutrition management in children with choledochal cysts undergoing laparoscopic cyst excision with jejunal Roux-en-Y anastomosis
Geng Xiao
Meng Xiaowan
Li Shixian
Cao Hui
Xu Yan
Fu Yu
Li Mengna
Abstract：Objective To evaluate the effects of perioperative stepwise combined enteral and parenteral nutrition management in children with choledochal cysts undergoing laparoscopic cyst excision combined with jejunal Roux-en-Y anastomosis,and to provide evidence for clinical decision-making.Methods In this prospective controlled study,80 children treated for choledochal cysts in the Department of General Surgery at Xuzhou Children's Hospital from June 2020 to June 2024 were randomized into an observation group(n=40)and a control group(n=40)using a random number table.Both groups underwent laparoscopic cyst excision with jejunal Roux-en-Y anastomosis and routine perioperative care.Postoperatively,the control group received parenteral nutrition alone,while the observation group received stepwise combined enteral and parenteral nutrition manage-ment.Surgical parameters,postoperative recovery,complication rates,and pre-and postoperative(day 7)nutritional status(serum albumin[ALB],prealbumin[PA],retinol-binding protein[RBP],hemoglobin[Hb])and inflammatory markers(C-reactive protein[CRP],interleukin-6[IL-6],interleukin-8[IL-8])were compared between the two groups.Results No significant differences between the two groups were noted in operative time or intraoperative blood loss(P＞0.05).No cases required conversion to open surgery.The observation group experienced shorter times to gastrointestinal function recovery,earlier removal of drainage tubes,and reduced total length of hospital stay compared with the control group(P＜0.05).The overall postoperative complication rate was 2.5％in the observation group and 7.5％in the control group,without a significant difference(P＞0.05).After surgery,both groups showed declines in ALB,PA,and RBP levels compared with preoperative values(P＜0.05),but the observation group maintained significantly higher ALB,PA,and RBP levels than the control group(P＜0.05).Postoperatively,CRP,IL-6,and IL-8 levels rose in both groups compared with preoperative levels(P＜0.05);however,the observation group's postoperative CRP,IL-6,and IL-8 levels were significantly lower than those of the control group(P＜0.05).Conclusion Perioperative stepwise combined enteral and parenteral nutrition management in children re-ceiving laparoscopic choledochal cyst excision with jejunal Roux-en-Y anastomosis promotes postoperative recovery and attenu-ates fluctuations in nutritional and inflammatory parameters induced by surgical stress.This approach merits wider promotion and application.
Keywords：Stepwise nutrition managementCholedochal cystLaparoscopeJejunal Roux-en-Y anastomosis
Publication Date：2025-05-20
Online Publishing Date：2025-09-04(First online date of this platform, not the publication date of the document)
Pages：6( 96-101 )