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Canadian consensus statement: enhanced recovery after surgery in bariatric surgery

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

In Canada, bariatric surgery continues to remain the most effective treatment for severe obesity and its comorbidities. As the number of bariatric surgeries continues to grow, 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. The objective of this review is to develop evidence-based ERAS guidelines for bariatric surgery.

Methods

A literature search of the MEDLINE database was performed using ERAS-specific search terms. Recently published articles with a focus on randomized controlled trials, systematic reviews, and meta-analyses were included. Quality of evidence and recommendations were evaluated using the GRADE assessment system.

Results

Canadian bariatric surgeons from six provinces and ten bariatric centers performed a review of the evidence surrounding ERAS in bariatric surgery and created consensus guidelines for 14 essential ERAS elements. Our main recommendations were (1) to encourage participation in a presurgical weight loss program; (2) to abstain from tobacco and excessive alcohol; (3) low-calorie liquid diet for at least 2 weeks prior to surgery; (4) to avoid preanesthetic anxiolytics and long-acting opioids; (5) unfractionated or low-molecular-weight heparin prior to surgery; (6) antibiotic prophylaxis with cefazolin ± metronidazole; (7) reduced opioids during surgery; (8) surgeon preference regarding intraoperative leak testing; (9) nasogastric intubation needed only for Veress access; (10) to avoid abdominal drains and urinary catheters; (11) to prevent ileus by discontinuing intravenous fluids early; (12) postoperative analgesia with acetaminophen, short-term NSAIDS, and minimal opioids; (13) to resume full fluid diet on first postoperative day; (14) early telephone follow-up with full clinic follow-up at 3–4 weeks.

Conclusions

The purpose of addressing these 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.

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Acknowledgements

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada

    Jerry T. Dang

  2. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Vivian G. Szeto

  3. Department of Surgery, London Health Sciences Centre, London, ON, Canada

    Ahmad Elnahas

  4. Department of Surgery, Dalhousie University, Halifax, NS, Canada

    James Ellsmere

  5. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Allan Okrainec & Timothy Jackson

  6. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Amy Neville

  7. Department of Surgery, University of British Columbia, Victoria, BC, Canada

    Samaad Malik

  8. Department of Surgery, University of British Columbia, Richmond, BC, Canada

    Ekua Yorke

  9. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Dennis Hong

  10. Department of Surgery, Université Laval, Quebec City, QC, Canada

    Laurent Biertho

  11. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Shahzeer Karmali

Authors
  1. Jerry T. Dang
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  2. Vivian G. Szeto
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  3. Ahmad Elnahas
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  4. James Ellsmere
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  5. Allan Okrainec
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  6. Amy Neville
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  7. Samaad Malik
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  8. Ekua Yorke
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  9. Dennis Hong
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  10. Laurent Biertho
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  11. Timothy Jackson
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  12. Shahzeer Karmali
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Corresponding author

Correspondence to Jerry T. Dang.

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Disclosure

Jerry T. Dang, Vivian G. Szeto, Ahmad Elnahas, James Ellsmere, Allan Okrainec, Amy Neville, Samaad Malik, Ekua Yorke, Dennis Hong, Laurent Biertho, Timothy Jackson, and Shahzeer Karmali have no conflicts of interest or financial ties to disclose.

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Dang, J.T., Szeto, V.G., Elnahas, A. et al. Canadian consensus statement: enhanced recovery after surgery in bariatric surgery. Surg Endosc 34, 1366–1375 (2020). https://doi.org/10.1007/s00464-019-06911-x

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