Postoperative feeding regimens after laparoscopic gastrostomy placement

Eric H. Rosenfeld, Kirea Mazzolini, Annalyn Demello, Yangyang R. Yu, Timothy C. Lee, Bindi Naik-Mathuria, Mark V. Mazziotti, Sohail R. Shah

Research output: Contribution to journalArticle

Abstract

Purpose: The objective of this study was to evaluate postoperative feeding regimens after laparoscopic gastrostomy placement and their effect on outcomes. Methods: Children 18 years of age or younger, who underwent laparoscopic gastrostomy placement at a tertiary-care academic children's hospital between January 2014 and October 2016, were reviewed. Data collected included patient characteristics, postoperative feeding regimen, and clinical outcomes. Statistical analysis was performed using Chi-square, Fisher's exact, and Wilcoxon Rank-Sum tests. Results: We reviewed the medical records of 270 children that underwent laparoscopic gastrostomy placement by 15 pediatric surgeons. The median age was 2.7 (interquartile range [IQR], 0.7-9.6) years, and 50% (n = 136) were male. The median body mass index was 15.5 (IQR, 14.0-17.5). Complications within 90 days included: granulation tissue (34%), leakage (17%), dislodgement (14%), and skin and soft-tissue infection (9%). Two patients returned to the operating room, 1 for a dislodged tube, and another for a volvulus within 10 days of gastrostomy tube placement. A subset analysis of outpatients that underwent elective laparoscopic gastrostomy placement showed variation in the day of initial feeds (0-2 postoperative days [POD]), method of initial feeds (continuous versus bolus) and choice of initial feeds (Pedialyte versus formula/breast milk). There was a significant difference in median hospital length of stay for early versus late initiation of feeds (POD 0: 2.1 days versus POD ≥1: 3.1 days, P < .01) without a difference in postoperative complications. Conclusion: There is substantial variation in the postoperative feeding regimen after laparoscopic gastrostomy. Initiation of early postoperative feeds may result in decreased length of stay without increasing complications.

Original languageEnglish (US)
Pages (from-to)1203-1208
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume27
Issue number11
DOIs
StatePublished - Nov 2017
Externally publishedYes

Keywords

  • Enteral nutrition
  • Gastrostomy
  • Laparoscopy
  • Standardized protocols

ASJC Scopus subject areas

  • Surgery

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    Rosenfeld, E. H., Mazzolini, K., Demello, A., Yu, Y. R., Lee, T. C., Naik-Mathuria, B., Mazziotti, M. V., & Shah, S. R. (2017). Postoperative feeding regimens after laparoscopic gastrostomy placement. Journal of Laparoendoscopic and Advanced Surgical Techniques, 27(11), 1203-1208. https://doi.org/10.1089/lap.2017.0295