Enhanced recovery protocol for single-anastomosis gastric bypass: outcomes in the immediate postoperative phase

Summary Background Whereas numerous studies have addressed outcomes after bariatric surgery, only a few have provided a detailed analysis of the immediate postoperative period. The aim of the present study was therefore to meticulously analyze the condition of patients during the first 16 h after single-anastomosis gastric bypass (SAGB). Methods A prospective consecutive analysis of pain, nausea, fatigue, dizziness, vomiting, and mobilization during the first 16 h after SAGB was performed in a fast-track optimized high-volume setting. Values were recorded by means of a visual analogue scale (VAS) every 15 min in the postoperative recovery unit (first 2 h) and every 2 h on the ward. Secondary outcomes were length of stay (LOS) and surgical complications. Results The mean pain, nausea, fatigue, and dizziness levels never exceeded VAS 4. Two thirds of patients never vomited, whereas one third vomited once or twice. The highest incidence of minor adverse events was, unsurprisingly, seen during the first 2 h after surgery. Although these early minor adverse events after operation were expected and highly acceptable, our data also showed that 10–20% of patients transiently reached VAS values of 7 or more. Two patients experienced minor complications (atelectasis and cellulitis at the trocar site). Conclusion Single-anastomosis gastric bypass can be carried out in an enhanced recovery program with a low degree of pain, nausea, fatigue, and dizziness, and with fast mobilization. However, 10–20% of patients reached VAS levels of 7 or more. Therefore, there is still room for improvement of postoperative regimens.