Postoperative ad lib feeding for hypertrophic pyloric stenosis

Purpose: The aim of this study was to compare three methods of postoperativ e feeding after pyloromyotomy for hypertrophic pyloric stenosis (HPS). Methods: The authors reviewed retrospectively the charts of 308 patients wh o underwent pyloromyotomy for HPS from 1984 to 1997. Nineteen patients had prolonged hospitalization for other reasons and were excluded from the stud y, leaving 289 patients for analysis. All procedures were performed by a si ngle group of pediatric surgeons. The individual preferences of these surge ons resulted in three different feeding schedules: R, strictly regimented ( >12 hours nothing by mouth, then incremental feeding over greater than or e qual to 24 hours), I, intermediate (>8 hours nothing by mouth, then increme ntal feeding over <24 hours), or A, ad lib (less than or equal to 4 hours n othing by mouth, with or without a single small feeding, then ad lib feedin gs). 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 mad e by a combination of physical examination findings and diagnostic image fo r most patients. An "olive" was palpated in 60.6% of the patients. Sixty pe rcent (60.4%) of patients had an upper gastrointestinal series performed, a nd 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 m ore 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 schedul e. No patient required additional therapy or readmission after tolerating t wo consecutive full feedings, suggesting that this might be a suitable disc harge criterion for most patients with HPS. J Pediatr Surg 34:959-961. Copy right (C) 1999 by W.B. Saunders Company.