Fast-track surgery in the treatment of Hirschsprung's disease: A prospective multicenter randomized controlled trial

Abstract

Background: Fast-track surgery (FTS) is a novel, promising and comprehensive for surgical patients and is beneficial for recovery. Prospective multicenter randomized controlled trials on fast-track surgery in the treatment of Hirschsprung’s disease (HD) are lacking. Objective: Our study aimed to evaluate the safety and efficacy of FTS in the treatment of HD and explore the underlying immunologic mechanism of FTS. Methods: A prospective multicenter randomized controlled trial was conducted from January 2010 to January 2015. The patients were randomly assigned into two groups and traditional managements group. The postoperative intestinal function recovery time, hospital stay, hospital expense were compared and analyzed. Blood samples were taken preoperatively (baseline), and 24, 72 hours after surgery. C-reactive protein, interleukin-6 and tumor necrosis factor-α as perioperative immunity parameters were evaluated. Results: Compared with the conventional group, fast-track surgery had significantly faster recovery of bowel movement (P<0.05) and significantly less hospital stay and hospital expense (P<0.05). Furthermore, FTS group effectively inhibited the release of post-operative inflammatory factors and yielded beneficial protection via cell immunity. Inflammatory reactions, based on C-reactive protein, interleukin-6, and tumor necrosis factor-α, were less intense following FTS group. Conclusions: Fast-track surgery in the treatment of HD was safe and effective. FTS could improve the bowel movement recovery, shorten hospital stay and reduce hospital expense. Moreover, FTS could attenuate postoperative stress reactions and accelerate rehabilitation for patients with HD. (Registered with ClinicalTrials.Gov, NCT02350088)