Postoperative emesis after laparoscopic pyloromyotomy in infantile hypertrophic pyloric stenosis

Abstract

Postoperative emesis in IHPS after LP requires careful evaluation as it can be a result of enteric viral infections, aggressive feeding protocols or GER. Decisions to perform reoperations for incomplete myotomy after LP due to PE are challenging.

Feeding Post-Pyloromyotomy: A Meta-analysis

“…Subgroup analyses were also attempted for the primary outcome of LOS for potential predictors of postoperative emesis including preoperative vomiting, duration of symptoms, dehydration of patients, gastroesophageal reflux, pyloric thickness, admission weight, operative weight, type of Ramstedt's pyloromyotomy (open or laparoscopic), and perioperative medication. 9,10 …”

“…Adibe et al 9 were thorough in their reporting and rigorous in their methods, resulting in a low risk of bias for "sequence generation," "incomplete outcome data," and "selective reporting." The majority of items were not described in Turnock and Rangecroft, 12 and therefore 5 of the 7 risk of bias outcomes were assessed as unclear.…”

“…Wheeler et al 14 also did not describe 3 of the 7 items, and although their method of sequence generation was assessed to be low risk, allocation concealment (unmarked, folded sheets) had a high risk of bias. In all 3 studies blinding was not possible for patients, personnel, or outcome assessors, and because outcomes may be influenced by this lack of blinding, these Table 2) The remaining 11 nonrandomized studies [1][2][3][4]9,13,[15][16][17][18]20 were assessed for methodological quality with the MINORS tool, 7 for which the majority of items were assessed similarly across studies (Table 1; see Supplemental Table 4 for greater detail). Few or no studies reported on the items "prospective collection of data" (reported in only 1 of 11 [9%] studies 16 ), "unbiased assessment of the study endpoint" (0 in 11 [0%] studies), and "prospective calculation of the study size" (0 in 11 [0%] studies).…”

“…Of these, 14 studies (and 1 companion study 11 ) met our predefined eligibility criteria and were included in this systematic review (Fig 1). [1][2][3][4]9,[12][13][14][15][16][17][18][19][20] Seven of the 14 studies compared feeding regimens that differed with respect to time of first feed (early versus late feeding), [2][3][4][12][13][14]20 6 studies compared the approach to feeding (ad libitum versus structured feeding), 1,3,[16][17][18][19] and 4 studies compared advancement of feeding (gradual versus rapid feeding) 4,9,14,15 ( Table 1 and Supplemental Table 3). Of the 14 studies included, only 3 (21%) used a randomized controlled trial study design, 12,14,19 and the remaining 11 studies (79%) used a nonrandomized comparative control approach.…”

“…Of the 14 studies included, only 3 (21%) used a randomized controlled trial study design, 12,14,19 and the remaining 11 studies (79%) used a nonrandomized comparative control approach. [1][2][3][4]9,13,[15][16][17][18]20 The majority originated in the United States (n = 7, 50%) 1,4,[15][16][17][18][19] or the United Kingdom (n = 3, 21%), 2,12,14 with 2 studies originating in Ireland (14%), 13,20 1 in the Netherlands (7%), 3 and 1 in Austria (7%) 9 (Table 1). A total of 2124 patients were followed in the 14 included studies.…”