Postoperative Care and Functional Recovery After Laparoscopic Sleeve Gastrectomy vs. Laparoscopic Roux-en-Y Gastric Bypass Among Patients Under ERAS Protocol

Abstract

BackgroundThe most commonly performed bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). There are major differences between LSG and LRYGB during postoperative period. Optimization of the postoperative care may be achieved by using enhanced recovery after surgery (ERAS) protocol, which allows earlier functional recovery.PurposeThe aim was to assess differences in the course of postoperative care conducted in accordance with ERAS protocol among patients after LSG and LRYGB.Material and MethodsData concerning patients treated for morbid obesity were prospectively gathered in one academic center. Patients were divided into two groups: LSG (n = 364, 63.41%) and LRYGB (n = 210, 36.59%). Multiple factors were used as endpoints to determine the influence of the type of bariatric procedure on postoperative course.ResultsThe rate of postoperative nausea and vomiting and incidence of intravenous fluid administration during the operation was higher in LSG group. LRYGB patients were able to tolerate higher oral fluid intake volumes during the first and the second postoperative day. Mean diuresis during the second and the third postoperative day was significantly higher in LRYGB group. Administration of diuretics and painkillers was comparable between groups, while the risk of fever after the operation was higher in LRYGB group. Mean length of stay was higher in LSG group (LRYGB vs. LSG, 3.46 days ± 1.58 vs. 3.64 days ± 4.41, p = 0.039).ConclusionsIn our opinion, postoperative treatment after LSG requires more supervision and longer time until functional recovery is achieved.

Laparoscopic sleeve gastrectomy: a study of efficiency in treatment of metabolic syndrome components, comorbidities and influence on certain biochemical markers.

“…Improvements in lipid metabolism caused by bariatric procedures are known in the scientific literature, but each operation technique induce changes with different intensity; thus an appropriate procedure should be selected for dyslipidemia severity in the patient [33,34]. During the follow-up we also observed pleiotropic improvements in many other obesity-related comorbidities, like other authors assessing patients after bariatric surgery [35,36]. Although observed clinical improvements in these diseases are significant and important, complete postoperative resolution in most comorbidities is rather rarely observed [37].…”

Outcomes of Sleeve Gastrectomy in Obese Liver Transplant Candidates

“…Additionally, we postulated that rapid weight loss in the posttransplant period resulting from a combined SG and LT procedure could make immunosuppressive management more challenging. Finally, as compared with simultaneous SG and LT, patients who undergo pre‐LT SG may have lower risk of intolerance to oral intake immediately after LT, which is especially important given that the optimization of nutritional intake is an integral component of immediate post‐LT care . Further investigation is needed to determine the optimal timing of SG in morbidly obese LT candidates, but an individualized approach will likely be necessary.…”

Integrative genomics reveal a role for MCPIP1 in adipogenesis and adipocyte metabolism

“…Patients from both groups were treated in accordance with the principles of the multimodal Enhanced Recovery After Surgery (ERAS) pathway. Exclusion criteria included occurrence of perioperative complications, history of cancer, severe liver disease, coagulopathy, and smoking or alcohol abuse [18]. The characteristic of patients was summarized in supplementary data (Table S1).…”