Enhanced Recovery After Bariatric Surgery

I have recently return from the Annual Scientific Meeting of the American Society of Metabolic and Bariatric Surgeons. This is one of the world’s largest scientific meetings of bariatric surgeons and is always a good opportunity to see what is new, what is coming up, and to meet up with colleagues from when I was working in the US. Although there were few surprise developments, it is interesting to see where things are going and where we in Aoteoroa/NZ sit compared to some of the busiest practices in the world.

In this regard, one not particularly headline grabbing, but very important development in the last few years is the so called ERAS or enhanced recovery after surgery pathways. These pathways developed over a decade ago with people undergoing surgery to remove portions of their large bowel. The include a large number of small interventions before surgery (such as limiting the period people have to fast), during surgery (such as laparoscopic surgery and anaesthetic techniques to reduce pain without using strong narcotics), and after surgery (such as letting people eat and walk much sooner). The cumulative effect for these interventions is that people recover from surgery quicker, with fewer complications.

The growth of ERAS across different surgical specialties paralleled the growth of laparoscopic bariatric surgery so many of the now accepted interventions, just became part of the standard care packages for bariatric surgery. This is all well and good, but about a year ago, bariatric surgeons in the US asked if we can do better. They looked at all the studies and evidence since ERAS pathways first developed and came up with a set of new interventions to further smooth people’s recovery after bariatric surgery. These include newer anaesthetic techniques and drugs, nerve blocks of the abdomen at the time of surgery, and moving physiotherapy from after surgery to before surgery where people are more able to take it in.

Second generation ERAS pathways for bariatric surgery have now been in use for long enough for the first results to come through and things look good. Most people are now only staying one night in hospital after surgery and complication rates and readmission rates are dropping. The best news however it that here at Aspiring Bariatrics we have already been adopting these techniques in our patient care pathways over the last few years, with the same results as high volume bariatric surgery centres in the US are reporting. While we are continuing the search to further improve things, I am constantly amazed that my patients mostly go home the day after major digestive surgery looking little different from someone who has had their gallbladder removed or a hernia repaired.

There was a lot of other interesting material covered at the conference including the toxic effects of sugar, how bariatric surgery can prevent cancer, weight loss medications, the one anastomosis (or loop) gastric bypass, and gastric balloons. I will plan to cover these topics with separate blog posts in the coming weeks.