Yeahwa Hong1, Frances Okolo1, Katrina Morgan1, Nicholas Hess1, Marissa Narr2, Athena Pyros2, Victoria Humphrey3, Marcus Malek4. 1. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 2. Division of Pediatric General and Thoracic Surgery, University of Pittsburgh Medical Center, 4401 Penn Ave, Pittsburgh, PA, 15224, USA. 3. University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Division of Pediatric General and Thoracic Surgery, University of Pittsburgh Medical Center, 4401 Penn Ave, Pittsburgh, PA, 15224, USA. Marcus.Malek@chp.edu.
Abstract
PURPOSE: In this study, we evaluated the impacts of ad libitum feedings on outcomes following laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis. METHODS: Pediatric patients with infantile hypertrophic pyloric stenosis who underwent laparoscopic pyloromyotomy were included. Patients were stratified into ad libitum and structured feeding groups. Primary outcomes were times from surgery completion to goal feeding and discharge. RESULTS: A total of 336 patients were included in the study with 63 patients (18.8%) in the ad libitum feeding group. The ad libitum feeding group experienced significantly shorter times from surgery completion to both goal feedings (10.7 h vs 18.7 h; p < 0.001) and hospital discharge (21.6 h vs 23.1 h; p = 0.008) compared to the structured protocol group. Postoperative emesis (47.% vs 30.8%; p = 0.011) was higher in the ab libitum cohort, but the rates of return to an emergency department and/or readmission (4.8% vs 2.2%; p = 0.26) were similar. CONCLUSION: Ad libitum feeding after pyloromyotomy decreases time to reach goal feeding and hospital discharge. While it may contribute to a higher incidence of emesis, it does not appear to significantly increase hospital readmission. Ad libitum feeding appears to be a safe and beneficial alternative to structured feeding protocols following pyloromyotomy. LEVEL OF EVIDENCE: III.
PURPOSE: In this study, we evaluated the impacts of ad libitum feedings on outcomes following laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis. METHODS: Pediatric patients with infantile hypertrophic pyloric stenosis who underwent laparoscopic pyloromyotomy were included. Patients were stratified into ad libitum and structured feeding groups. Primary outcomes were times from surgery completion to goal feeding and discharge. RESULTS: A total of 336 patients were included in the study with 63 patients (18.8%) in the ad libitum feeding group. The ad libitum feeding group experienced significantly shorter times from surgery completion to both goal feedings (10.7 h vs 18.7 h; p < 0.001) and hospital discharge (21.6 h vs 23.1 h; p = 0.008) compared to the structured protocol group. Postoperative emesis (47.% vs 30.8%; p = 0.011) was higher in the ab libitum cohort, but the rates of return to an emergency department and/or readmission (4.8% vs 2.2%; p = 0.26) were similar. CONCLUSION: Ad libitum feeding after pyloromyotomy decreases time to reach goal feeding and hospital discharge. While it may contribute to a higher incidence of emesis, it does not appear to significantly increase hospital readmission. Ad libitum feeding appears to be a safe and beneficial alternative to structured feeding protocols following pyloromyotomy. LEVEL OF EVIDENCE: III.
Authors: R O Carpenter; R L Schaffer; C E Maeso; F Sasan; J G Nuchtern; T Jaksic; F J Harberg; D E Wesson; M L Brandt Journal: J Pediatr Surg Date: 1999-06 Impact factor: 2.545
Authors: Renuka Kapoor; Vijaya Kancherla; Yanyan Cao; Jacob Oleson; Jonathan Suhl; Mark A Canfield; Charlotte M Druschel; Russell S Kirby; Robert E Meyer; Paul A Romitti Journal: Birth Defects Res Date: 2018-12-13 Impact factor: 2.344
Authors: Jennifer J Garza; Donna Morash; Alexander Dzakovic; Joshua K Mondschein; Tom Jaksic Journal: J Pediatr Surg Date: 2002-03 Impact factor: 2.545
Authors: Brandon H Hidaka; Elizabeth H Kerling; Jocelynn M Thodosoff; Debra K Sullivan; John Colombo; Susan E Carlson Journal: BMC Pediatr Date: 2016-11-25 Impact factor: 2.125