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SAGES

Reimagining surgical care for a healthier world

  • Introduction
  • Preoperative
  • Intraoperative
  • Postoperative
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    • Frequently Asked Questions (FAQ)
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Bariatric – Enhanced Recovery Pathway

Preoperative

Patient attends preoperative visit with surgeon (1-2 weeks prior to surgery) to discuss post-operative course and expectations
Patient attends a separate educational class reaffirming short and long term expectations and recognizing complications
Patient given binder with all encompassing information related to perioperative journey

Patient given post-op scripts and 2 years of follow up appointments

2 week liquid diet prior to surgery if BMI > 45
NPO > 2400

Operative

Fluid management and Urine output:

  1. intraop fluids limited to 1L
  2. Foley not placed vs placed, but removed POD1

Intraop nausea management:

  1. Decadron 8 mg
  2. scopolamine patch for sleeve gastrectomy

Intraop pain management:

  1. local long acting anesthetic at all incision sites and preperitoneal
  2. toradol 30 mg

VTE prophylaxis:

  1. preop lovenox 40mg
  2. SCD

Postoperative

Fluid management:

  1. limited to 100cc/h
  2. hep lock in AM if tolerating liquids
  3. liquid diet started 2 hours after surgery

Nausea management:

  1. Zofran
  2. Phenergan

Pain management:

  1. PCA (morphine or dilaudid) until POD1
  2. Liquid narcotic POD1
  3. Around the clock toradol

VTE prophylaxis:

  1. SCD while in bed
  2. Lovenox 40mg continued 14 days post op

Anticipated discharge for patients is POD1
80%+ patients are discharged POD1orPOD2

No routine use of drains

No contrast studies to rule out leak (selective use of contrast study to evaluate anatomy of sleeve gastrectomy, however, this does not delay onset of PO intake)

3,248

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Related

Surgery Type
Bowel
Building Blocks
Case Studies

SAGES Enhanced Recovery

SAGES improves quality patient care through education, research, innovation and leadership, principally in gastrointestinal and endoscopic surgery.

Representing a worldwide community of more than 6,000 surgeons, SAGES sets the clinical and educational guidelines on standards of practice in various procedures, critical to enhancing patient safety and health.

SAGES Support

SAGES gratefully acknowledges Medtronic for its generous educational grant in support of the SMART Enhanced Recovery Program.

Preoperative
Intraoperative
Postoperative

SAGES Smart Task Force

  • Liane Feldman, Chair
  • Thomas Aloia, Co-Chair
  • Gina Adrales
  • Rajesh Aggarwal
  • Joselin Anandam
  • Conor Delaney
  • Diana Diesen
  • Justin Dimick
  • Julio Fiore Jr.
  • Gerald Fried
  • Pascal Fuchshuber
  • I. Gorgun
  • Alexis Grucela
  • Matthew Hutter
  • Edmundo Inga-Zapata
  • Rohan Joseph
  • Deborah Keller
  • Anne Lidor
  • David Liska
  • Sumeet Mittal
  • Charles Paget III
  • Michele Riordon
  • Vadim Sherman
  • Andrew Wright
  • Tonia Young-Fadok
  • Yulia Zak

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

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Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

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