Aim of study
Impaired gastric motility immediately post pyloromyotomy hinder timely discharge. Different feeding regimes have been studied: comparing protocolised gradual build-up versus ad libitum, or early versus late feed initiation. Though evidence demonstrated reduced episodes of emesis with gradual build up, it has not shorten length of stay (LOS). We report 15 years of experience by a single surgeon in post-operative management of laparoscopic pyloromyotomy following early initiation of small volume protocol feed with rapid liberalisation.
Analysis of prospectively collected database 2003 - 2017. All patients underwent laparoscopic pyloromyotomy under the care of senior author were included. Post operative feeding regime: 30ml milk-feed 3 hourly, to start 3 hours post anaesthetics. Child is then allowed to feed freely after 2 successful 30ml feed. Patient discharged after 2 consecutive ad-libertum feed with minimal vomiting. LOS <24 hours = 1 day. Telephone follow-up conducted 2 weeks post operatively.
103 infants underwent laparoscopic pyloromyotomy. 10% was born pre-term with gestation ranging 27-36 weeks. Medium weight on admission 3.8kg (2.5 - 5.7kg). 71% were discharged on day 1. Of the 30 not able to go home within 24 hours of the procedure: 6 stayed for social reasons; 13 were discharged the day after; 1 extreme preterm stayed for 10 days; 1 mucosal perforation repaired during index operation was discharged on day 5. 1 incomplete myotomy requiring reoperation. 7 patients were put on short term ranitidine post-op, 6 of those stayed beyond day 1. No other complications reported during telephone follow-up. No surgical outpatient clinic required.
Simple post-operative feeding protocol with rapid ad-libertum build up allowing for small volume vomits facilitate discharge within 24 hours. This is a safe practice with financial benefit of early discharge and no formal follow-up.
Graph 1. LOS *extra day stay for social reason.