ENHANCED RECOVERY AFTER SURGERY IN BARIATRIC SURGERY - REVIEW
Abstract
Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, evidence-based approach designed to optimize perioperative care, improve patient outcomes, and shorten hospital stays. This review examines the application of ERAS protocols in bariatric surgery—a critical intervention for the management of severe obesity and related comorbidities. Key components of ERAS in this context include preadmission counselling, minimized preoperative fasting, goal-directed fluid therapy, opioid-sparing anaesthesia techniques, and structured postoperative nutritional support. Current evidence indicates that adherence to ERAS protocols significantly reduces postoperative complications, accelerates recovery, and shortens the length of hospitalization. Moreover, ERAS has been associated with decreased incidence of postoperative nausea, improved pain control, and reduced reliance on opioids. The role of anaesthesiologists is pivotal in ERAS implementation, and standardized surgical techniques are essential for ensuring patient safety and consistency of care. Overall, this review highlights the growing importance of ERAS in bariatric surgery, emphasizing its effectiveness in enhancing both short- and long-term outcomes.
References
Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952. PMID: 28097305.
Schwenk W. Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery. GMS Hyg Infect Control. 2022 Jun 23;17:Doc10. doi: 10.3205/dgkh000413. PMID: 35909653; PMCID: PMC9284431
Mayoral LP, Andrade GM, Mayoral EP, Huerta TH, Canseco SP, Rodal Canales FJ, Cabrera-Fuentes HA, Cruz MM, Pérez Santiago AD, Alpuche JJ, Zenteno E, Ruíz HM, Cruz RM, Jeronimo JH, Perez-Campos E. Obesity subtypes, related biomarkers & heterogeneity. Indian J Med Res. 2020 Jan;151(1):11-21. doi: 10.4103/ijmr.IJMR_1768_17. PMID: 32134010; PMCID: PMC7055173.
Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014 Aug 27;349:g3961. doi: 10.1136/bmj.g3961. PMID: 25164369; PMCID: PMC4707708.
Runkel N, Colombo-Benkmann M, Hüttl TP, Tigges H, Mann O, Sauerland S. Bariatric surgery. Dtsch Arztebl Int. 2011 May;108(20):341-6. doi: 10.3238/arztebl.2011.0341. Epub 2011 May 20. PMID: 21655459; PMCID: PMC3109275.
Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007 Oct;142(4):621-32; discussion 632-5. doi: 10.1016/j.surg.2007.07.018. PMID: 17950357.
Shi X, Karmali S, Sharma AM, Birch DW. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010 Aug;20(8):1171-7. doi: 10.1007/s11695-010-0145-8. PMID: 20379795.
Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg. 2023 Jan;33(1):3-14. doi: 10.1007/s11695-022-06332-1. Erratum in: Obes Surg. 2023 Jan;33(1):15-16. doi: 10.1007/s11695-022-06369-2. PMID: 36336720; PMCID: PMC9834364.
Stenberg E, Dos Reis Falcão LF, O'Kane M, Liem R, Pournaras DJ, Salminen P, Urman RD, Wadhwa A, Gustafsson UO, Thorell A. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World J Surg. 2022 Apr;46(4):729-751. doi: 10.1007/s00268-021-06394-9. Epub 2022 Jan 4. Erratum in: World J Surg. 2022 Apr;46(4):752. doi: 10.1007/s00268-022-06459-3. PMID: 34984504; PMCID: PMC8885505.
Halliday TA, Sundqvist J, Hultin M, Walldén J. Post-operative nausea and vomiting in bariatric surgery patients: an observational study. Acta Anaesthesiol Scand. 2017 May;61(5):471-479. doi: 10.1111/aas.12884. PMID: 28374473.
Groene P, Eisenlohr J, Zeuzem C, Dudok S, Karcz K, Hofmann-Kiefer K. Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery. Wideochir Inne Tech Maloinwazyjne. 2019 Jan;14(1):90-95. doi: 10.5114/wiitm.2018.77629. Epub 2018 Oct 3. PMID: 30766634; PMCID: PMC6372858.
Kushner BS, Freeman D, Sparkman J, Salles A, Eagon JC, Eckhouse SR. Assessment of postoperative nausea and vomiting after bariatric surgery using a validated questionnaire. Surg Obes Relat Dis. 2020 Oct;16(10):1505-1513. doi: 10.1016/j.soard.2020.05.017. Epub 2020 May 28. PMID: 32665115.
Ingrande J, Brodsky JB, Lemmens HJ. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg. 2011 Jul;113(1):57-62. doi: 10.1213/ANE.0b013e3181f6d9c0. Epub 2010 Sep 22. PMID: 20861415.
Servin F, Farinotti R, Haberer JP, Desmonts JM. Propofol infusion for maintenance of anesthesia in morbidly obese patients receiving nitrous oxide. A clinical and pharmacokinetic study. Anesthesiology. 1993 Apr;78(4):657-65. doi: 10.1097/00000542-199304000-00008. PMID: 8466066.
Cortínez LI, De la Fuente N, Eleveld DJ, Oliveros A, Crovari F, Sepulveda P, Ibacache M, Solari S. Performance of propofol target-controlled infusion models in the obese: pharmacokinetic and pharmacodynamic analysis. Anesth Analg. 2014 Aug;119(2):302-310. doi: 10.1213/ANE.0000000000000317. PMID: 24977639.
Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg. 2018 Dec;28(12):3783-3794. doi: 10.1007/s11695-018-3450-2. PMID: 30121858.
Luján JA, Frutos MD, Hernández Q, Liron R, Cuenca JR, Valero G, Parrilla P. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg. 2004 Apr;239(4):433-7. doi: 10.1097/01.sla.0000120071.75691.1f. PMID: 15024302; PMCID: PMC1356246.
Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001 Sep;234(3):279-89; discussion 289-91. doi: 10.1097/00000658-200109000-00002. PMID: 11524581; PMCID: PMC1422019.
Westling A, Gustavsson S. Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg. 2001 Jun;11(3):284-92. doi: 10.1381/096089201321336610. PMID: 11433902.
Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. CLINICAL PRACTICE GUIDELINES FOR THE PERIOPERATIVE NUTRITION, METABOLIC, AND NONSURGICAL SUPPORT OF PATIENTS UNDERGOING BARIATRIC PROCEDURES - 2019 UPDATE: COSPONSORED BY AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY, THE OBESITY SOCIETY, AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY, OBESITY MEDICINE ASSOCIATION, AND AMERICAN SOCIETY OF ANESTHESIOLOGISTS - EXECUTIVE SUMMARY. Endocr Pract. 2019 Dec;25(12):1346-1359. doi: 10.4158/GL-2019-0406. Epub 2019 Nov 4. PMID: 31682518.
Daigle CR, Brethauer SA, Tu C, Petrick AT, Morton JM, Schauer PR, Aminian A. Which postoperative complications matter most after bariatric surgery? Prioritizing quality improvement efforts to improve national outcomes. Surg Obes Relat Dis. 2018 May;14(5):652-657. doi: 10.1016/j.soard.2018.01.008. Epub 2018 Jan 12. PMID: 29503096.
Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med. 2000 Dec 11-25;160(22):3415-20. doi: 10.1001/archinte.160.22.3415. PMID: 11112234.
Clark LN, Helm MC, Gould JC. Practice patterns regarding post-discharge chemoprophylaxis for venous thromboembolism following bariatric surgery in the United States. Surg Obes Relat Dis. 2019 May;15(5):703-707. doi: 10.1016/j.soard.2019.02.017. Epub 2019 Mar 20. PMID: 31005460.
Shoar S, Poliakin L, Rubenstein R, Saber AA. Single Anastomosis Duodeno-Ileal Switch (SADIS): A Systematic Review of Efficacy and Safety. Obes Surg. 2018 Jan;28(1):104-113. doi: 10.1007/s11695-017-2838-8. PMID: 28823074.
O'Kane M, Parretti HM, Pinkney J, Welbourn R, Hughes CA, Mok J, Walker N, Thomas D, Devin J, Coulman KD, Pinnock G, Batterham RL, Mahawar KK, Sharma M, Blakemore AI, McMillan I, Barth JH. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obes Rev. 2020 Nov;21(11):e13087. doi: 10.1111/obr.13087. Epub 2020 Aug 2. PMID: 32743907; PMCID: PMC7583474.Shoar S, Poliakin L, Rubenstein R, Saber AA. Single Anastomosis Duodeno-Ileal Switch (SADIS): A Systematic Review of Efficacy and Safety. Obes Surg. 2018 Jan;28(1):104-113. doi: 10.1007/s11695-017-2838-8. PMID: 28823074.
Parrott JM, Craggs-Dino L, Faria SL, O'Kane M. The Optimal Nutritional Programme for Bariatric and Metabolic Surgery. Curr Obes Rep. 2020 Sep;9(3):326-338. doi: 10.1007/s13679-020-00384-z. PMID: 32451780.
Zhou B, Ji H, Liu Y, Chen Z, Zhang N, Cao X, Meng H. ERAS reduces postoperative hospital stay and complications after bariatric surgery: A retrospective cohort study. Medicine (Baltimore). 2021 Nov 24;100(47):e27831. doi: 10.1097/MD.0000000000027831. PMID: 34964750; PMCID: PMC8615334.
Zandomenico JG, Trevisol FS, Machado JA. Compliance with Enhanced Recovery After Surgery (ERAS) protocol recommendations for bariatric surgery in an obesity treatment center. Braz J Anesthesiol. 2023 Jan-Feb;73(1):36-41. doi: 10.1016/j.bjane.2021.10.018. Epub 2021 Dec 25. PMID: 34963616; PMCID: PMC9801194.
Lam J, Suzuki T, Bernstein D, Zhao B, Maeda C, Pham T, Sandler BJ, Jacobsen GR, Cheverie JN, Horgan S. An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative day 1? Surg Endosc. 2019 Feb;33(2):580-586. doi: 10.1007/s00464-018-6368-9. Epub 2018 Aug 17. PMID: 30120584.
Fantola G, Agus M, Runfola M, Podda C, Sanna D, Fortunato F, Pintus S, Moroni R. How can lean thinking improve ERAS program in bariatric surgery? Surg Endosc. 2021 Aug;35(8):4345-4355. doi: 10.1007/s00464-020-07926-5. Epub 2020 Aug 27. PMID: 32856155.
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