Postoperative ad lib feeding for hypertrophic pyloric stenosis

Purpose: The aim of this study was to compare three methods of postoperative feeding after pyloromyotomy for hypertrophic pyloric stenosis (HPS). Methods: The authors reviewed retrospectively the charts of 308 patients who underwent pyloromyotomy for HPS from 1984 to 1997. Nineteen patients had prol...

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Bibliographic Details
Published in:	Journal of pediatric surgery Vol. 34; no. 6; pp. 959 - 961
Main Authors:	Carpenter, R.O, Schaffer, R.L, Maeso, C.E, Sasan, F, Nuchtern, J.G, Jaksic, T, Harberg, F.J, Wesson, D.E, Brandt, M.L
Format:	Journal Article Conference Proceeding
Language:	English
Published:	Philadelphia, PA Elsevier Inc 01-06-1999 Elsevier
Subjects:	Biological and medical sciences Feeding Methods Female Gastroenterology. Liver. Pancreas. Abdomen Humans Hypertrophy Infant Infant, Newborn Male Malformations Medical sciences Postoperative Care Pyloric Stenosis - pathology Pyloric Stenosis - surgery Pylorus - surgery Retrospective Studies Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Time Factors postoperative complications pyloromyotomy Hypertrophic pyloric stenosis Human Postoperative Malformation Surgery Pylorus Digestive diseases Infant Congenital disease Pyloromyotomy Hypertrophic stenosis Gastric disease Feeding
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Summary:	Purpose: The aim of this study was to compare three methods of postoperative feeding after pyloromyotomy for hypertrophic pyloric stenosis (HPS). Methods: The authors reviewed retrospectively the charts of 308 patients who underwent pyloromyotomy for HPS from 1984 to 1997. Nineteen patients had prolonged hospitalization for other reasons and were excluded from the study, leaving 289 patients for analysis. All procedures were performed by a single group of pediatric surgeons. The individual preferences of these surgeons resulted in three different feeding schedules: R, strictly regimented (>12 hours nothing by mouth, then incremental feeding over ≥24 hours), I, intermediate (>8 hours nothing by mouth, then incremental feeding over <24 hours), or A, ad lib (≤4 hours nothing by mouth, with or without a single small feeding, then ad lib feedings). Results: Of the 289 patients, 248 (80.5%) were boys. The average age of the patients was 5.64 weeks (range, 1 to 21 weeks). A total of 265 of 289 (92%) were full term. Thirty-nine of 289 (13.5%) had a family history positive for pyloric stenosis. A total of 104 of 289 (36%) were first-born infants, 89 of 289 (31%) were second born. The diagnosis of pyloric stenosis was made by a combination of physical examination findings and diagnostic image for most patients. An “olive” was palpated in 60.6% of the patients. Sixty percent (60.4%) of patients had an upper gastrointestinal series performed, and 42.5% were examined by ultrasonography. Overall, 53% of the patients had postoperative emesis. Only 3.5% had emesis that persisted greater than 48 hours after surgery. Patients fed ad lib after pyloromyotomy had slightly more emesis (2.2 A v 1.2 R, and 0.7 I episodes, P = .002), but tolerated full feedings sooner than patients fed with a regimented or intermediate schedule. No patient required additional therapy or readmission after tolerating two consecutive full feedings, suggesting that this might be a suitable discharge criterion for most patients with HPS.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-3468 1531-5037
DOI:	10.1016/S0022-3468(99)90768-6