Pyloric Stenosis Post-Op Guideline

Post-Op from Pyloromyotomy NPO x 2 hours Initiate home feeds (breast milk or formula) ad lib** Discharge when tolerates 3 consecutive feeds without emesis Continue ad lib even if patient has 2-3 episodes of emesis If persistent emesis, can make patient NPO x 2 hours and then re-start feeds Updated 1/2019 v1.0Sources:•Markel TA, et al. A randomized trial to assess advancement of enteral feeds following surgery for hypertrophic pyloric stenosis.J PediatrSurg2017;52(4):534-539. •AdibeOO, et al. Protocol versus ad libitum feeds after laparoscopic pyloromyotomy: A prospective randomized trial. J PediatrSurg2014;49(1):129-132. •Graham KA, et al. A review of postoperative feeding regimens in infantile hypertrophic pyloric stenosis. J PediatrSurg2013;48:2175-2179. **Note: Ad lib feeding is associated with equivalent or shorter hospital stay (compared to protocolized feeding), although patients on ad lib feeds may have more emesis.