FAST Discharge for Laparoscopic G-tube
With Dr. Ray Hanke · hosted by Dr. Todd Ponsky · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
G-tube placement is one of the most common procedures pediatric surgeons perform, and more frequently this is being done laparoscopically.
There is little data on the efficacy of early feeding after laparoscopic G-tube placement, though previous studies have examined when to start feeds after percutaneous G-tube placement.
The study by Hendrickson and Tuji at Children's Mercy Hospital in Kansas City evaluated the feasibility and safety of an early feeding and expedited recovery discharge pathway after laparoscopic G-tube placement.
The study performed a retrospective review of 545 patients, excluding inpatients or those without prior nasal gastric feeding, with final analysis including 122 patients.
Following the institution protocol, patients underwent standardized laparoscopic GT placement, recovered in PACU postoperatively, and were started on feeding within 4 hours of transfer to the floor bed.
Patients were started at full or partial feeds (1/2 to 1/3) depending on the surgeon.
For patients with bolus feeds, the volume was increased to goal over the next 2 feed cycles.
For patients with continuous feeds, they were advanced to goal volume every 2 to 3 hours.
Feeds were held if the patient became intolerant, defined as abdominal distention, abdominal discomfort unrelieved by pain medications, emesis, respiratory difficulties, or hemodynamic instability.
Median operative length was 19 minutes.
Median time to initiation of feeds was 2.8 hours from arrival on the floor.
33% of patients reached full volume within 1 hour of starting feeds, 70% within 12 hours, and 97% of patients reached full enteral nutrition within 24 hours.
Median length of stay was 26 hours.
4 patients had difficulties with early initiation of feeding, and all were able to resume feeds after negative G tube studies.
For patients undergoing elective laparoscopic G tube placement who already had established nasogastric feeding regimens, a standardized pathway of starting feeds right after recovery in PACU and advancing to goal quickly is well tolerated and safe.
The early feeding protocol can lead to decreased length of stay.