Enhanced recovery after bariatric surgery – a modern approach

Purpose of review. The aim of the work is to collect in a single whole the disparate information devoted to certain aspects of ERAS methods application for the creation of the project of Ukrainian-language recommendations on optimization of perioperative period in the bariatric patients. Recent findings. Bariatric surgery today is a gold standard in the long-term treatment of morbid obesity and associated comorbid conditions such as metabolic syndrome, type 2 diabetes, and others. Laparoscopic longitudinal resection of the stomach (LPRS) and gastric bypass graft (LSH) are the most common bariatric interventions in the world. But despite the fact that the global epidemic of obesity for several decades has had an impact on perioperative tactics of the management of barrier patients, there is currently a relative lack of management in the treatment of this group of patients. They still feel pain and are traditionally injecting opioids for early postoperative analgesia, suffering from nausea and vomiting, which significantly delay the onset of enteral nutrition and prolong the duration of hospitalization. Consequently, postoperative pain, PONV and malnutrition, rather than factors associated with the operation, often lead to prolonged hospitalization and elimination of which benefits the healthcare system and patients by returning them home earlier. Protocols of Enhanced Recovery After Surgery (ERAS), introduced in medical practice Prof. Kehlet in the nineties of the last century, widely used in various fields of surgeons. The most studied application of these protocols in colorectal, thoracic surgery and operative urology. There are recent studies and meta-analyzes that have demonstrated the feasibility of introducing ERAS into bariatric surgery. In 2016, recommendations were published on the implementation of ERAS components in bariatric surgery. The ERABS protocol has been implemented in many Western European bariatric centers and includes the best practice of preoperative preparation and standardization of perioperative and post-operative care that will provide rapid recovery and improve treatment outcome. But it remains unclear whether all components of the classical protocol, namely, epidural anesthesia, are necessary for successful implementation in bariatric surgery. Conclusions. ERAS protocols are successfully used in obese patients after bariatric surgery, and the principles of multimodal analgesia minimize the need for opioids. The principles of ERAS have already proved themselves in many clinics and should be reflected in the National Clinical Recommendations for Bariatric Surgery.

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Enhanced recovery after bariatric surgery – a modern approach

Cited by 6 publications

References 42 publications

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Perioperative management in bariatric surgery using eras

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