Enhanced recovery after bariatric surgery.

Abstract

Enhanced recovery after surgery (ERAS) methodology has demonstrated consistent benefits in patients undergoing colorectal, urological and thoracic surgeries. Principles of these protocols and their advantages are expected to extend into other surgical specialties such as bariatric surgery. In this review, we summarize the components of ERAS protocols for bariatric surgery and present the evidence on the emerging role of ERAS principles in obese patients. Many recent trials have evaluated ERAS protocols for bariatric surgery. Most of these protocols originate from modifications within the individual hospital-based conventional perioperative care strategies. Studies demonstrate that 'ERAS based' care requires evidence-based modifications in all preoperative, intraoperative and postoperative phase. Despite a lack of standardization in protocols at present, benefits such as decreased length of hospital stay, rapid patient turnover, shorter operating room times and lower healthcare costs have been well demonstrated repeatedly. ERAS for bariatric surgery is in its early phase. Nevertheless, literature supports its role in improving perioperative outcomes compared with conventional care in this scenario. Evidence-based protocols, multidisciplinary teamwork and meticulous audit seem to be the key factors for success in ERAS methodology.