Comparison of perioperative surgical outcomes following total robotic and total laparoscopic Roux-en Y hepaticojejunostomy for choledochal cyst in paediatric population: a preliminary report from a tertiary referral centre.

PURPOSE: There is a paucity of data regarding the comparison of robotic and laparoscopic hepaticojejunostomy (HJ) for the treatment of paediatric choledochal cysts. Thus, our primary objective was a comparison of early complications namely post-operative bleeding, anastomotic leak, intestinal obstruction and the need for reoperation in both techniques. Our secondary objectives included a comparison of the mean time for surgery and HJ, conversion of procedure to open, intraoperative blood loss, late complications like cholangitis, stricture and post-operative outcomes like time to start oral feeds and length of post-operative stay. METHODS: A retrospective data analysis of all children who underwent laparoscopic and robotic choledochal cyst excision with Roux-en-Y HJ from 2008 to 2021 was performed. RESULTS: Ninety patients were classified into Group R (robotic HJ), n = 20 and Group L (laparoscopic HJ), n = 70. Post-operative complications were comparable amongst groups R and L (2 vs 6; p = 1 and 1 vs 2, p = 0.53, respectively). Intraoperative blood loss was significantly less in group R (54.8 ± 13.5 ml vs 64.1 ± 17.3 ml; p = 0.0280). The mean time to complete HJ was significantly less in group R (58 ± 12 min vs 71 ± 11 min; p < 0.001) while the mean time to complete surgery was significantly more in Group R (284 ± 14 min vs 195 ± 18 min; p < 0.001). CONCLUSION: Our preliminary research report suggests overall comparable early complications in both groups.

Influence of Parental Awareness Drive on Preoperative Fasting Compliance in Pediatric Day Care Surgery.

Context: Optimum preoperative fasting is imperative for the prevention of aspiration in pediatric patients. The current guidelines advocate 2-4-6 rule for the same. However, direct supervision is lacking in large volume centers. Aims: Thus, we aimed to determine the fasting compliance of children preoperatively and to ascertain whether parents understood the significance and purpose of optimum fasting. Materials and Methods: Design - A prospective questionnaire-based study regarding preoperative fasting was performed in pediatric patients aged 1-10 years scheduled for "day care surgery" or "same day admission surgery" over 12 weeks. Thereafter, parental awareness drive was carried out, and a re-audit was performed with a questionnaire in the next cohort of patients. Results: The number of patients in the pre and postcounseling groups were 98 and 99. Thirteen percent of the patients were optimally fasted for solids initially. Re-audit confirmed compliance increased to 46%. Patients fasting adequately (2-3 h) for clear fluids increased from 22.4% to 51.5% postcounseling. The number for optimally breast-fed children increased postaudit (23.1%-39.1%). Consequent to the drive, parental awareness increased and 49.5% parents knew that only plain water was permitted during fasting. Number of parents considering preoperative fasting important increased from 39.8% to 79.7%. Initially, 27.6% of the parents did not know the reason for fasting, which reduced to 3% postaudit. Conclusion: Parents are misinformed and ignorant about optimum preoperative fasting. Adequate education and awareness to improve their knowledge was associated with increased compliance for optimal fasting.