The utilisation of enhanced recovery after surgery programmes in sleeve gastrectomy

Abstract

© 2017 Nova Science Publishers, Inc. Enhanced Recovery After Surgery (ERAS), or fast track programmes, integrate multiple evidence based perioperative care interventions to standardise and optimise perioperative care. Their use has been shown to reduce perioperative morbidity and, as a result, reduce the length of hospital stay. They have also been shown to be cost effective. The use of ERAS was initially popularised in colorectal surgery but there is now an increasing volume of evidence demonstrating the effectiveness of ERAS in the setting of bariatric surgery. The early literature reporting on ERAS in bariatric surgery was in the setting of laparoscopic roux-en-Y gastric bypass (LRYGB) where case series demonstrated a reduction in the length hospital stay. However, the use of ERAS has now been evaluated in patients undergoing sleeve gastrectomy (SG) with a recent randomised controlled trial showing a similar reduction in length of hospital stay as well as improved cost effectiveness without increasing perioperative morbidity. Whilst consensus regarding ERAS constituents was reached in a recent report detailing guidelines for its implementation in bariatric surgery, it is important to know that some recommendations are based on data extrapolated from non-bariatric surgery. Also, length of stay remains only a proxy of surgical recovery and that the aim of ERAS is to reduce perioperative morbidity which should be a primary focus of future studies.