Protocol versus ad libitum feeds after laparoscopic pyloromyotomy: a prospective randomized trial.

Area of Science:

• Pediatric Surgery
• Gastroenterology

Background:

• Laparoscopic pyloromyotomy is a surgical procedure for infants with pyloric stenosis.
• Postoperative feeding protocols significantly impact recovery and hospital stay.

Purpose of the Study:

• To compare the efficacy of protocolized versus ad libitum feeding on postoperative outcomes after laparoscopic pyloromyotomy.
• To determine the impact of feeding strategies on the length of hospital stay in infants.

Main Methods:

• A prospective, randomized trial involving 150 infants undergoing laparoscopic pyloromyotomy.
• Infants were randomized to either a protocol feeding group or an ad libitum feeding group.
• Primary outcome was the length of postoperative hospitalization; secondary outcomes included time to goal feeds and incidence of emesis.

Main Results:

• No significant difference in the length of postoperative hospitalization between the two groups.
• Infants in the ad libitum group reached goal feeds more rapidly than those in the protocol group.
• The ad libitum group experienced more emesis after reaching goal feeds, with no difference in readmission rates.

Conclusions:

• While ad libitum feeding accelerates reaching goal feeds post-laparoscopic pyloromyotomy, it does not shorten hospitalization duration.
• The timing of reaching goal feeds often extends beyond typical discharge parameters.
• Current feeding strategies yield similar hospitalization lengths, suggesting a need for optimized discharge criteria.