Early Mobilization and Return to Physical Activity Following Common Pediatric Abdominal Surgery: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.72.74819Keywords
pediatric abdominal surgery, early mobilization, physical activity, return to sport, Enhanced Recovery After Surgery, ERAS, pediatric surgery, postoperative recoveryAbstract
Background. Early mobilization is a key component of Enhanced Recovery After Surgery (ERAS) pathways and is increasingly incorporated into pediatric abdominal surgery. However, evidence regarding the optimal timing of return to physical activity after common pediatric abdominal procedures remains limited.
Aim. To summarize the current evidence on early mobilization and return to physical activity following common pediatric abdominal surgery, evaluate the role of ERAS pathways, and identify areas requiring further research.
Material and methods. A narrative literature review was conducted using PubMed and Web of Science. Publications available up to 2026 were screened, and 21 studies investigating early mobilization, postoperative activity restrictions, return to physical activity, and ERAS in pediatric abdominal surgery were included.
Results. Current evidence indicates that early mobilization within multimodal ERAS pathways accelerates gastrointestinal recovery, facilitates earlier oral feeding, reduces opioid use, shortens hospital stay, and does not consistently increase postoperative complications. Recovery after appendectomy and inguinal hernia repair is generally rapid, whereas evidence defining the optimal timing of return to unrestricted physical activity remains limited. In pediatric colorectal surgery, ERAS protocols improve short-term recovery, although the specific contribution of early mobilization cannot yet be determined.
Conclusions. Early mobilization is a safe and valuable component of postoperative recovery following common pediatric abdominal surgery, particularly as part of ERAS pathways. Nevertheless, further prospective multicenter studies are needed to establish evidence-based recommendations for return to physical activity and sport in pediatric surgical patients.
References
1. Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40. Published 2010 May 11. https://doi.org/10.1186/1479-5868-7-40
2. Wu XY, Han LH, Zhang JH, Luo S, Hu JW, Sun K. The influence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review. PLoS One. 2017;12(11):e0187668. Published 2017 Nov 9. https://doi.org/10.1371/journal.pone.0187668
3. Rachel Harvey, Angela England, Diane Studzinski, Robert Morden, Nathan Novotny, Anthony Stallion, Begum Akay, Pavan Brahmamdam, Let them play: A prospective study of postoperative activity restrictions in children, Journal of Pediatric Surgery Open, Volume 3,2023. https://doi.org/10.1016/j.yjpso.2023.100051.
4. Gao R, Yang H, Li Y, et al. Enhanced recovery after surgery in pediatric gastrointestinal surgery. J Int Med Res. 2019;47(10):4815-4826. https://doi.org/10.1177/0300060519865350
5. Roberts K, Brindle M, McLuckie D. Enhanced recovery after surgery in paediatrics: a review of the literature. BJA Educ. 2020;20(7):235-241. https://doi.org/10.1016/j.bjae.2020.03.004
6. Leeds IL, Boss EF, George JA, Strockbine V, Wick EC, Jelin EB. Preparing enhanced recovery after surgery for implementation in pediatric populations. J Pediatr Surg. 2016;51(12):2126-2129. https://doi.org/10.1016/j.jpedsurg.2016.08.029
7. Loganathan AK, Joselyn AS, Babu M, Jehangir S. Implementation and outcomes of enhanced recovery protocols in pediatric surgery: a systematic review and meta-analysis. Pediatr Surg Int. 2022;38(1):157-168. https://doi.org/10.1007/s00383-021-05008-8
8. Gibb ACN, Crosby MA, McDiarmid C, et al. Creation of an Enhanced Recovery After Surgery (ERAS) Guideline for neonatal intestinal surgery patients: a knowledge synthesis and consensus generation approach and protocol study. BMJ Open. 2018;8(12):e023651. Published 2018 Dec 9. https://doi.org/10.1136/bmjopen-2018-023651
9. Hidayah BA, Toh ZA, Cheng LJ, et al. Enhanced recovery after surgery in children undergoing abdominal surgery: meta-analysis. BJS Open. 2023;7(1):zrac147. https://doi.org/10.1093/bjsopen/zrac147
10. Ames SG, Watson RS, Fink EL. Return to Ambulation After Pediatric Liver Transplantation: A First “Step” in Assessing the Impact of Early Mobility. Pediatr Crit Care Med. 2019;20(2):209-211. https://doi.org/10.1097/pcc.0000000000001837
11. Frazee RC, Roberts JW, Symmonds RE, et al. A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg. 1994;219(6):725-731. https://doi.org/10.1097/00000658-199406000-00017
12. Zheng Y, Qi S. Feasibility of Same-Day Discharge After Appendectomy in Pediatric Patients: A Systematic Review and Meta-Analysis. Front Pediatr. 2022;10:944405. Published 2022 Jul 4. https://doi.org/10.3389/fped.2022.944405
13. Reynolds E, Kohler JE, Wieck MM. Quantifying recovery time after common pediatric surgical procedures. J Pediatr Surg. 2026;61(1):162593. https://doi.org/10.1016/j.jpedsurg.2025.162593
14. Al-Taher R, Alshahwan H, Abdelhadi S, et al. Enhanced recovery concepts in paediatric patients who underwent appendectomy: a retrospective cohort study at a tertiary university hospital. J Int Med Res. 2023;51(2):3000605231158524. https://doi.org/10.1177/03000605231158524
15. Ionescu S, Andrei B, Licsandru E, Ivanov M, Ionescu A; -. Laparoscopic treatment for complicated acute appendicitis in children, junior athletes. Chirurgia (Bucur). 2014;109(4):514-517. PMID: 25149615
16. Dreuning K, Maat S, Twisk J, van Heurn E, Derikx J. Laparoscopic versus open pediatric inguinal hernia repair: state-of-the-art comparison and future perspectives from a meta-analysis. Surg Endosc. 2019;33(10):3177-3191. https://doi.org/10.1007/s00464-019-06960-2
17. Eakes AM, Purcell LN, Burkbauer L, et al. The Effect of an Enhanced Recovery Protocol on Pediatric Colorectal Surgical Patient Outcomes at a Single Institution. Am Surg. 2023;89(8):3438-3443. https://doi.org/10.1177/00031348231161673
18. Su Y, Xu L, Hu J, Musha J, Lin S. Meta-Analysis of Enhanced Recovery After Surgery Protocols for the Perioperative Management of Pediatric Colorectal Surgery. J Pediatr Surg. 2023;58(9):1686-1693. https://doi.org/10.1016/j.jpedsurg.2022.11.017
19. Chara AO, Sims JK, Niconchuk J, Zamora IJ. Impact of enhanced recovery after surgery (ERAS) on surgical site infections in pediatric surgery. Semin Pediatr Surg. 2026;40:151581. https://doi.org/10.1016/j.sempedsurg.2026.151581
20. Zhu LB, Li YF, Shu JT, et al. Enhanced recovery after surgery in congenital duodenal obstruction. BMC Gastroenterol. 2023;23(1):423. Published 2023 Nov 30. https://doi.org/10.1186/s12876-023-03057-y
21. Flucher C, Windhaber J, Gasparella P, et al. Long-term motor activity, cardiopulmonary performance and quality of life in abdominal wall defect patients. Pediatr Res. 2024;95(4):1101-1109. https://doi.org/10.1038/s41390-023-02900-y
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Copyright (c) 2026 Zoja Goti, Magdalena Markiewicz-Zahorski, Jan Damian, Julia Jaszczyńska, Filip Kęska, Maria Michalska, Aleksandra Markiewicz-Zahorski, Tomasz Kałużny, Zofia Łubniewska
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