Experience with an Enhanced Recovery After Surgery (ERAS) Program for Bariatric Surgery: Comparison of MGB and LSG in 374 Patients

Blanchet, Marie-Cécile; Gignoux, B; Matussière, Yann; Vulliez, Alexandre; Lanz, T.; Monier, F; Frering, Vincent

doi:10.1007/s11695-017-2694-6

Cited by 47 publications

(26 citation statements)

References 16 publications

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“…The complication rates in a fast-track bariatric surgery are modest: 2%–4% of all patients undergoing a bariatric procedure develops a major complication, such as staple line leakage or haemorrhage 13 14. Haemorrhage is not a frequently seen complication, but does have a substantial impact on the patient’s recovery.…”

Section: Discussionmentioning

confidence: 99%

Trial protocol: preoperative administration of tranexamic acid in sleeve gastrectomy (PATAS) to reduce haemorrhage rates. A randomised controlled trial

et al. 2020

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IntroductionFast-track protocols often include short-term thromboprophylaxis and short length of hospital stay. These treatment strategies may negatively affect the occurrence and diagnosis of postoperative haemorrhage. Over the years, the rates of venous thromboembolic events (VTEs) have decreased, while there seems to be an increase in the occurrence of postoperative haemorrhage. Tranexamic acid (TXA) can potentially lower the incidence of postoperative haemorrhage. This trial aims to investigate whether preoperative administration of TXA reduces the preoperative and postoperative haemorrhage rates in laparoscopic sleeve gastrectomy (LSG).Methods and analysisThis is a single centre double-blind randomised placebo-controlled trial. Patients undergoing an LSG are included after obtaining informed consent. Patients are randomised between two groups: (1) administration of placebo infusion and (2) administration of 1500 mg TXA. In both groups, the infusions will be administered during the induction phase of the procedure. Primary outcome measures are preoperative use of haemostatic clips, postoperative haemoglobin decrease and postoperative haemorrhage. Secondary outcome measure is the rates of VTE.Ethics and disseminationThe protocol version 3 was approved by the medical ethical committee Medical Research Ethics Committees United (MEC-U), Nieuwegein, on 29 July 2019. The trial results will be submitted for publication in a peer-reviewed journal and at conference presentations.Trial registration numberThe Netherlands Trial Registry (NL8029); Pre-results.

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Section: Discussionmentioning

confidence: 99%

Trial protocol: preoperative administration of tranexamic acid in sleeve gastrectomy (PATAS) to reduce haemorrhage rates. A randomised controlled trial

et al. 2020

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“…Patients were encouraged to be active agents of their own well-being instead of passive recipients of a surgical process. The detailed process of patients moving through the preoperative, operative, and postoperative ERAS protocol and follow-up, including the MGB and LSG procedures performed, and anesthesia and analgesia employed, has been described in detail in our original bariatric ERAS publication [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…During the 4-year development of our center’s bariatric ERAS protocol, we found that the use of thrombophylaxis selectively, only in morbidly obese postoperatively high-risk patients, was effective in ensuring safe outcomes while achieving more rapid mobilization [ 16 ]. The program’s evolution began in 2012 with a feasibility study of same-day discharge for patients undergoing laparoscopic adjustable gastric banding (LAGB).…”

Section: Introductionmentioning

confidence: 99%

“…In 2013, we offered outpatient colectomy, publishing the results of this procedure in 2015 (LOS < 12 h, n = 20) [ 17 ]. In early 2017, we reported outcomes of a prospective patient series begun in 2012 ( n = 374) that incorporated a bariatrics-specific ERAS protocol, the first study of ERAS in morbidly obese patients undergoing omega loop gastric bypass (“mini” gastric bypass, MGB) vs laparoscopic sleeve gastrectomy (LSG) [ 16 ]. Time in the operating room was < 45 min, and mean LOS was 1.2 days, a briefer LOS than that reported in a meta-analysis of ERAS with bariatric surgery [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…The success of the adjusted protocol in the remainder of our original bariatric series appeared to confirm that postoperative LMWH was not necessary in patients at low risk of DVT (Caprini score < 3) [ 16 ]. Based on these findings, the current follow-on study was designed to assess outcomes in a prospective MGB and LSG cohort systematically treated using our bariatric ERAS protocol with the revised LMWH decision tree.…”

Section: Introductionmentioning

confidence: 99%

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Four-Year Evolution of a Thrombophylaxis Protocol in an Enhanced Recovery After Surgery (ERAS) Program: Recent Results in 485 Patients

Blanchet¹,

Frering²,

Gignoux³

et al. 2018

OBES SURG

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“Enhanced recovery after surgery” (ERAS) protocols may reduce morbidity, length of hospital stay (LOS), and costs. During the 4-year evolution of a bariatric ERAS protocol, we found that administration of thrombophylaxis selectively to high-risk morbidly obese patients (assessed postoperatively by Caprini score ≥ 3) undergoing omega loop gastric bypass (“mini” gastric bypass) or sleeve gastrectomy resulted in safe outcomes. Both procedures proved equally effective with this protocol. The vast majority of rapidly mobilized, low-risk patients did not appear to require antithrombotic heparin. Similar to other reported ERAS outcomes, our recent year’s results in 485 patients included a mean LOS of 1.08 ± 0.64 days (range 1–14), with 460 (95.0%) discharged on day 1 and 99.6% by day 2. There were 13 30-day complications (2.7%), two reinterventions (0.4%), and no hemorrhages.

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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 and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

324

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Experience with an Enhanced Recovery After Surgery (ERAS) Program for Bariatric Surgery: Comparison of MGB and LSG in 374 Patients

Abstract: The program was equally safe with both procedures. Postoperative antithrombotic heparin does not appear necessary in low-risk patients. Bariatric surgical ERAS programs are evolving and not yet standardized.

Cited by 47 publications

References 16 publications

Trial protocol: preoperative administration of tranexamic acid in sleeve gastrectomy (PATAS) to reduce haemorrhage rates. A randomised controlled trial

Trial protocol: preoperative administration of tranexamic acid in sleeve gastrectomy (PATAS) to reduce haemorrhage rates. A randomised controlled trial

Four-Year Evolution of a Thrombophylaxis Protocol in an Enhanced Recovery After Surgery (ERAS) Program: Recent Results in 485 Patients

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