Top

Published in:

01-04-2022 | Nausea | Original Article

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

Authors: Yeahwa Hong, Frances Okolo, Katrina Morgan, Nicholas Hess, Marissa Narr, Athena Pyros, Victoria Humphrey, Marcus Malek

Published in: Pediatric Surgery International | Issue 4/2022

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.

Kapoor R, Kancherla V, Cao Y et al (2019) Prevalence and descriptive epidemiology of infantile hypertrophic pyloric stenosis in the United States: a multistate, population-based retrospective study, 1999–2010. Birth Defects Res 111(3):159–169. https://doi.org/10.1002/bdr2.1439CrossRefPubMed

Aboagye J, Goldstein SD, Salazar JH et al (2014) Age at presentation of common pediatric surgical conditions: reexamining dogma. J Pediatr Surg 49(6):995–999. https://doi.org/10.1016/j.jpedsurg.2014.01.039CrossRefPubMed

Rogers IM (1997) The enigma of pyloric stenosis. Some thoughts on the aetiology. Acta Paediatr 86(1):6–9. https://doi.org/10.1111/j.1651-2227.1997.tb08821.xCrossRefPubMed

Svenningsson A, Svensson T, Akre O, Nordenskjöld A (2014) Maternal and pregnancy characteristics and risk of infantile hypertrophic pyloric stenosis. J Pediatr Surg 49(8):1226–1231. https://doi.org/10.1016/j.jpedsurg.2014.01.053CrossRefPubMed

Niedzielski J, Kobielski A, Sokal J, Krakós M (2011) Accuracy of sonographic criteria in the decision for surgical treatment in infantile hypertrophic pyloric stenosis. Arch Med Sci 7(3):508–511. https://doi.org/10.5114/aoms.2011.23419CrossRefPubMedPubMedCentral

Lee AC, Munro FD, MacKinlay GA (2001) An audit of post-pyloromyotomy feeding regimens. Eur J Pediatr Surg 11(1):12–14. https://doi.org/10.1055/s-2001-12198CrossRefPubMed

Schärli AF, Leditschke JF (1968) Gastric motility after pyloromyotomy in infants. A reappraisal of postoperative feeding Surgery 64(6):1133–1137PubMed

Sullivan KJ, Chan E, Vincent J et al (2016) Feeding post-pyloromyotomy: a meta-analysis. Pediatrics. https://doi.org/10.1542/peds.2015-2550CrossRefPubMedPubMedCentral

Carpenter RO, Schaffer RL, Maeso CE et al (1999) Postoperative ad lib feeding for hypertrophic pyloric stenosis. J Pediatr Surg 34(6):959–961. https://doi.org/10.1016/s0022-3468(99)90768-6CrossRefPubMed

10.

Garza JJ, Morash D, Dzakovic A, Mondschein JK, Jaksic T (2002) Ad libitum feeding decreases hospital stay for neonates after pyloromyotomy. J Pediatr Surg 37(3):493–495. https://doi.org/10.1053/jpsu.2002.30874CrossRefPubMed

11.

Puapong D, Kahng D, Ko A, Applebaum H (2002) Ad libitum feeding: safely improving the cost-effectiveness of pyloromyotomy. J Pediatr Surg 37(12):1667–1668. https://doi.org/10.1053/jpsu.2002.36687CrossRefPubMed

12.

Adibe OO, Nichol PF, Lim FY, Mattei P (2007) Ad libitum feeds after laparoscopic pyloromyotomy: a retrospective comparison with a standardized feeding regimen in 227 infants. J Laparoendosc Adv Surg Tech A 17(2):235–237. https://doi.org/10.1089/lap.2006.0143CrossRefPubMed

13.

Georgeson KE, Corbin TJ, Griffen JW, Breaux CW Jr (1993) An analysis of feeding regimens after pyloromyotomy for hypertrophic pyloric stenosis. J Pediatr Surg 28(11):1478–1480. https://doi.org/10.1016/0022-3468(93)90435-nCrossRefPubMed

14.

van der Bilt JD, Kramer WL, van der Zee DC, Bax NM (2004) Early feeding after laparoscopic pyloromyotomy: the pros and cons. Surg Endosc 18(5):746–748. https://doi.org/10.1007/s00464-003-9076-yCrossRefPubMed

15.

To T, Wajja A, Wales PW, Langer JC (2005) Population demographic indicators associated with incidence of pyloric stenosis. Arch Pediatr Adolesc Med 159(6):520–525. https://doi.org/10.1001/archpedi.159.6.520CrossRefPubMed

16.

Gibbs MK, Van Herrden JA, Lynn HB (1975) Congenital hypertrophic pyloric stenosis. Surgical experience. Mayo Clin Proc 50(6):312–316PubMed

17.

Spicer RD (1982) Infantile hypertrophic pyloric stenosis: a review. Br J Surg 69(3):128–135. https://doi.org/10.1002/bjs.1800690304CrossRefPubMed

18.

Adibe OO, Iqbal CW, Sharp SW et al (2014) Protocol versus ad libitum feeds after laparoscopic pyloromyotomy: a prospective randomized trial. J Pediatr Surg 49(1):129–132. https://doi.org/10.1016/j.jpedsurg.2013.09.044CrossRefPubMed

19.

Wheeler RA, Najmaldin AS, Stoodley N, Griffiths DM, Burge DM, Atwell JD (1990) Feeding regimens after pyloromyotomy. Br J Surg 77(9):1018–1019. https://doi.org/10.1002/bjs.1800770921CrossRefPubMed

20.

Turnock RR, Rangecroft L (1991) Comparison of postpyloromyotomy feeding regimens in infantile hypertrophic pyloric stenosis. J R Coll Surg Edinb 36(3):164–165PubMed

Title: Safety and benefit of ad libitum feeding following laparoscopic pyloromyotomy: retrospective comparative trial
Authors: Yeahwa Hong
Frances Okolo
Katrina Morgan
Nicholas Hess
Marissa Narr
Athena Pyros
Victoria Humphrey
Marcus Malek
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Nausea
Pyloromyotomy
Pyloric Stenosis
Pyloric Stenosis
Published in: Pediatric Surgery International / Issue 4/2022
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-022-05084-4

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 4/2022

Patient-level costing analysis of paediatric short bowel syndrome care in a specialist tertiary centre

One- versus two-stage single-incision laparoscopic cyst excision and hepaticojejunostomy in patients with completely perforated choledochal cysts and good medical conditions

Surgery versus conservative management in congenital lobar emphysema: follow up and indicators for surgery

Laparoscopic management of infantile hydrocele in pediatric age group

Surgery, a multi-dimensional entry point for World Birth Defects Day-March 3

Sacrococcygeal teratomas: midline reconstruction improves cosmesis without compromising outcomes