Feeding Advancement and Simultaneous Transition to Discharge (FASTDischarge) after laparoscopic gastrostomy

J Pediatr Surg. 2018 Nov;53(11):2326-2330. doi: 10.1016/j.jpedsurg.2018.04.035. Epub 2018 May 4.


Background: Laparoscopic gastrostomy (LG) is a common surgical procedure. However, there is little consensus on a postoperative feeding regimen. With prior nasogastric feed tolerance, there should be no delay in resumption of feeds and subsequent discharge to home. This is a report on a Feeding Advancement and Simultaneous Transition-Discharge (FAST-Discharge) pathway, which to date has not been reported in the literature.

Methods: A retrospective review of patients who underwent LG was performed from May 2010 to May 2015. All were outpatients who were on prior nasogastric feeds. The postoperative order set initiates feeds in 4 h to advance to goal as tolerated. Time to initial feed and goal nutrition, and overall length of stay (LOS) were evaluated.

Results: 122 patients were identified with 55% percent being male and with a median operative age of 15 months (IQR 8-27). 53% were started on bolus feeds. Initial feeds were started at a median of 2.8 h (IQR: 1.8-4.7). The median duration to goal nutrition was 6 h (IQR: 0-14). 97% reached full feeds within 24 h with no complications related to feed advancement. Median LOS was 26 h (IQR: 24-30).

Conclusion: An expedited pathway with early feeding and discharge is possible after laparoscopic gastrostomy tube placement with a low risk for adverse events.

Level of evidence: Level III.

Keywords: Early feeding trial; Enhanced recovery protocol; Laparoscopic gastrostomy tube.

MeSH terms

  • Clinical Protocols*
  • Enteral Nutrition*
  • Female
  • Gastrostomy / methods*
  • Humans
  • Infant
  • Intubation, Gastrointestinal
  • Laparoscopy / methods*
  • Length of Stay
  • Male
  • Patient Discharge*
  • Retrospective Studies
  • Time Factors