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Obesity Surgery

, Volume 24, Issue 5, pp 753–758

First Online: 20 December 2013

Abstract

There is paucity of data on Enhanced Recovery After Bariatric Surgery ERABS protocols.
This feasibility study reports outcomes of this protocol utilized within a tertiary-referral bariatric centre.
Data on consecutive primary procedures laparoscopic gastric bypasses, sleeve gastrectomies and gastric bands performed over 9 months within an ERABS protocol were prospectively recorded.
Interventions utilized included shortened preoperative fasts, intra-operative humidification, early mobilization and feeding, avoidance of fluid overload, incentive spirometry, use of prokinetics and laxatives.
Data collected included demographics, co-morbidities, morbidity, mortality, length of stay LOS and re-admissions.
A total of 226 procedures age mean ± SD, 45 ± 11 years, median interquartile range BMI 44.9 41.0–49.0 kg-m were undertaken: 150 66 % bypasses, 47 21 % sleeves and 29 13 % bands.
Hypertension, diabetes mellitus, sleep apnea and limited mobility were present in 40 %, 34 %, 24 % and 9 % of patients, respectively.
No anastomotic or staple line leaks-bleeds were encountered.
Ten 4.4 % patients developed postoperative morbidity mainly respiratory complications.
One death occurred from massive pulmonary embolus in a high-risk patient despite insertion of preoperative-IVC filter.
Respective mean ± SD LOS for bypasses, sleeves and bands were 1.88 ± 1.12, 2.30 ± 1.69 and 0.69 ± 0.81 days.
Successful discharge on the first postoperative day was achieved in 37 % and 28 % of bypasses and sleeves, respectively.
Day-case gastric bands were performed in 48 %.
Thirty-day hospital re-admission occurred in six 2.7 % patients.
Applying an ERABS protocol was feasible, safe, associated with low morbidity, acceptable LOS and low 30-day re-admission rates.
The presence of multiple medical co-morbidities should not preclude use of an ERABS protocol within bariatric patients.

KeywordsMorbid obesity Gastric bypass Sleeve gastrectomy Gastric band Laparoscopic Enhanced recovery Fast track Length of stay Complications Bariatric surgery Co-morbidities Preliminary data from this study were presented at the 4th Annual Conference of the British Obesity and Metabolic Surgery Society BOMSS, Glasgow, January 2013, and were published in abstract form in British Journal of Surgery 2013; 100S3: 3.
The final data were presented at IFSO, Turkey, August 2013, and have been published in abstract form in Obesity Surgery 2013; 23: 1213.

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Autor: Sherif Awad - Sharon Carter - Sanjay Purkayastha - Sherif Hakky - Krishna Moorthy - Jonathan Cousins - Ahmed R. Ahmed

Fuente: https://link.springer.com/article/10.1007/s11695-013-1151-4



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