Safety and benefit of ad libitum feeding following laparoscopic pyloromyotomy: retrospective comparative trial

Hong, Yeahwa; Okolo, Frances C.; Morgan, Katrina M.; Hess, Nicholas R.; Narr, Marissa; Pyros, Athena; Humphrey, Victoria; Malek, Marcus M.

doi:10.1007/s00383-022-05084-4

Cited by 3 publications

(5 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the past, slow initiation of feedings was common practice based on studies reporting that normal gastric peristalsis occurs 24 hours after pyloromyotomy. 2 Before 2015, our institution used a feeding protocol consisting of initial feedings of Pedialyte two hours after surgery, progressing to multiple rounds of half-strength formula or breast milk before allowing the patient to resume their home feeding regimen. When this feeding protocol was compared to the ad libitum feeds in a randomized clinical trial, the mean time to full feedings was 16.6 hours and 9.2 hours, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertrophic pyloric stenosis (HPS) has an incidence of 2 to 5 per 1000 live births and most commonly affects males. 1,2 The gastric outlet obstruction caused by the abnormal thickness of the pyloric wall results in non-bilious, projectile vomiting in the first 3-6 weeks of life. Preoperative correction of serum electrolyte disturbances is paramount.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…There is no consensus on a specific feeding protocol after surgical correction, but studies have shown that ad libitum feeds are associated with decreased time to reach goal feedings and hospital discharge. 2,3,5 In 2015, our institution implemented a standardized evidence-based protocol focused on the perioperative and postoperative management of patients with HPS. 6 This protocol provides a practical algorithm for fluid resuscitation in the preoperative period, avoids unnecessary blood draws, and allows immediate postoperative feedings, limiting unnecessary discomfort to the child.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hypertrophic Pyloric Stenosis Protocol: A Single Center Study

Cruz-Centeno

Fraser

Stewart

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

Background Initial treatment of hypertrophic pyloric stenosis (HPS) is correction of electrolyte disturbances with fluid resuscitation. In 2015, our institution implemented a fluid resuscitation protocol based on previous data that focused on minimizing blood draws and allowing immediate ad libitum feeds postoperatively. Our aim was to describe the protocol and subsequent outcomes. Methods We conducted a single-center retrospective review of patients diagnosed with HPS from 2016 to 2023. All patients were given ad libitum feeds postoperatively and discharged home after tolerating three consecutive feeds. The primary outcome was the postoperative hospital length of stay (LOS). Secondary outcomes included the number of preoperative labs drawn, time from arrival to surgery, time from surgery to initiation of feeds, time from surgery to full feeds, and re-admission rate. Results The study included 333 patients. A total of 142 patients (42.6%) had electrolytic disturbances that required fluid boluses in addition to 1.5x maintenance fluids. The median number of lab draws was 1 (IQR 1,2), with a median time from arrival to surgery of 19.5 hours (IQR 15.3,24.9). The median time from surgery to first and full feed was 1.9 hours (IQR 1.2,2.7) and 11.2 hours (IQR 6.4,18.3), respectively. Patients had a median postoperative LOS of 21.8 hours (IQR 9.7,28.9). Re-admission rate within the first 30 postoperative days was 3.6% ( n = 12) with 2.7% of re-admissions occurring within 72 hours of discharge. One patient required re-operation due to an incomplete pyloromyotomy. Discussion This protocol is a valuable tool for perioperative and postoperative management of patients with HPS while minimizing uncomfortable intervention.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hypertrophic Pyloric Stenosis Protocol: A Single Center Study

Cruz-Centeno

Fraser

Stewart

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

show abstract

“…While there is an ongoing debate about the optimal feeding regimen following laparoscopic pyloromyotomy, there is consensus that ad libitum feeding is highly effective ( 56 - 58 ). This is because ad libitum feeding helps decrease the time required to reach goal feeding.…”

Section: Hypertrophic Pyloric Stenosismentioning

confidence: 99%

Evidence-based advances in minimally invasive surgery in infants with congenital gastrointestinal anomalies: a narrative review

Liang,

Ganji,

Alganabi

et al. 2024

Transl Pediatr

View full text Add to dashboard Cite

Background and Objective Minimally invasive surgery (MIS) has been widely utilized to manage congenital gastrointestinal (GI) anomalies in children during the last two decades. Currently, MIS has a proven track-record for its feasibility and provides multiple benefits including better cosmesis, less trauma, and faster recovery in neonates and infants. However, it remains controversial whether MIS provides better definitive outcomes in pediatric patients with GI anomalies, especially among neonates. We aim to review the recent developments of MIS in infants with GI defects, assisting surgeons in making decisions and improving patient outcomes. Methods A comprehensive literature search of PubMed and Web of Science’s core collection was performed using terms of MIS techniques and congenital GI anomalies. Key Content and Findings This review summarizes recent evidence-based advances of MIS in infants with congenital GI defects and potential future strategies based on evidence. Better cosmetic results, less postoperative pain, and an accelerated recovery have been shown to be common advantages of MIS relative to open approaches. Technical hurdles and metabolic disturbance were reported to be the main reasons for the decisions of open approach. Conclusions Advanced techniques of MIS have made more precise manipulations and better outcomes possible, even for newborns. At the same time, surgeons should not be afraid to use an open approach in certain circumstances due to technical limitations or patient tolerance. The difficulty infants face in expressing their true feelings underscores the need for systematic and objective assessment tools to evaluate surgical outcomes.

show abstract