Jerry T Dang, MD1, Vivian Szeto, MSc1, Ahmad Elnahas, MD, MSc2, James Ellsmere, MD, MSc3, Allan Okrainec, MD, MSc4, Amy Neville, MD, MSc5, Samaad Malik, MD, MSc6, Ekua Yorke, MD6, Dennis Hong, MD, MSc7, Laurent Biertho, MD8, Timothy Jackson, MD, MPH4, Shahzeer Karmali1. 1University of Alberta, 2London Health Sciences Centre, 3Dalhousie University, 4University of Toronto, 5University of Ottawa, 6University of British Columbia, 7McMaster University, 8Universite Laval
Introduction: The objective of this study was to develop evidence-based consensus guidelines for optimal perioperative care in bariatric surgery. With roughly 20% of Canadians estimated to suffer from obesity, bariatric surgery continues to remain the most effective treatment to reduce severe obesity and its respective comorbidities. As the number of bariatric surgeries continues to grow exponentially, the need for consensus guidelines for optimal perioperative care is imperative. In colorectal surgery, Enhanced Recovery After Surgery (ERAS) protocols were created for this purpose. Therefore, the intention of this review is to develop similar ERAS guidelines for bariatric surgery.
Methods and Procedures: A literature search of the MEDLINE database was performed from January 1966 to August 2018 using search terms: “bariatric surgery”, “sleeve gastrectomy”, “gastric bypass”, “fast track” and “enhanced recovery”. Search terms for specific ERAS elements were also included. Recently published articles with a focus on randomized control trials, systematic reviews and meta-analysis were included in the study. Conference proceedings were excluded. Quality of evidence and recommendations were evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
Results: A group of Canadian bariatric surgeons from six different provinces and ten bariatric centres performed a review of the evidence surrounding ERAS in bariatric surgery and created consensus guidelines for 14 essential ERAS elements. These elements included addressing preadmission information and counselling for patients and their relatives prior to the surgery. As well, consensus was developed on patient optimization including smoking cessation and abstinence from excessive alcohol. Bowel preparation was not recommended. Consensus was reached on preoperative fasting in the form of a low-calorie diet for at least two weeks. In addition to these elements, the group addressed how to best manage pre-anesthetic medication, thromboprophylaxis, preoperative premedication and antimicrobial prophylaxis. The optimal anesthetic protocol was also reviewed; as well as intraoperative leak testing and nasogastric intubation. In terms of post-operative care, consensus was achieved for the following elements: abdominal and urinary drainage, preventing postoperative ileus, postoperative analgesia, postoperative nutrition and lastly, discharge and follow-up.
Conclusion: The purpose of addressing these 14 essential ERAS elements is to develop guidelines that can be implemented and practiced clinically. ERAS is an excellent model that improves surgical efficiency and acts as a common perioperative pathway. In the interim, this multimodal bariatric perioperative guideline serves as a common consensus point for Canadian bariatric surgeons.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93832
Program Number: S107
Presentation Session: Bariatric III – Optimizing Care and Pathways
Presentation Type: Podium
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