Enhanced recovery after bariatric surgery in super-obese patients undergoing laparoscopic sleeve gastrectomy: A retrospective study of feasibility, safety, and short-term outcomes

This study compares the feasibility, safety, and clinical outcomes of enhanced recovery after surgery (ERAS) protocol between patients with obesity (O) and super-obesity (SO). A retrospective analysis of clinical database from January 2017 to June 2022 in Department of general surgery, Tianjin Medical University General Hospital was performed. All patients were screened by a multidisciplinary team before surgery and underwent laparoscopic sleeve gastrectomy. Compare the pre-, intra- and postoperative characteristics between O group (body mass index [BMI] 27.5-50 kg/m², 378 patients) and SO group (BMI ≥ 50 kg/m², 37 patients). A total of 415 patients were included (378 in O group, 37 in SO group). No significant difference was observed in overall ERAS protocol compliance between groups (79.11 ± 5.46% vs 78.18 ± 5.43%, P = .904). SO patients had significantly longer operative time (124.19 ± 46.97 vs 98.23 ± 32.98 minutes, P = .002), higher rates of unplanned trocar insertion (13.5% vs 1.9%, P < .001), and intensive care unit admission (24.3% vs 4.2%, P < .001). However, hospital length of stay was similar (6.08 ± 0.72 vs 5.85 ± 1.44 days, P = .345). Despite higher incidence of lateral femoral cutaneous nerve neuritis in SO group, overall complication rates showed no significant difference. At 30-day follow-up, SO group demonstrated greater absolute weight loss (18.21 ± 4.06 vs 13.66 ± 4.33 kg, P < .001) and BMI reduction (6.32 ± 2.06 vs 4.67 ± 1.06 kg/m², P < .001), while percentage excess weight loss was higher in O group (38.71 ± 18.97% vs 21.04 ± 5.03%, P < .001). Our data demonstrate that the implementation of ERAS protocol in SO patients could ensure effective weight loss without increasing incidence of complications and readmissions.