FAST Discharge for Laparoscopic G-tube

Previous studies have examined when to start feeds after percutaneous G-tube placement

There is little data on the efficacy of early feeding after laparoscopic G-tube placement

The study by Hendrickson and Tuji performed a retrospective review of 545 patients, with final analysis including 122 patients after excluding inpatients or those without prior nasal gastric feeding

Patients 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

The early feeding protocol can lead to decreased length of stay

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% of patients reached full volume within 12 hours

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