Implementation of perioperative anesthetic management in morbide obese patiens undergoing laparascopic bariatric surgeryaccording to enhanced recovery program

Objective: to assess the feasibility of introducing a modified ERAS protocol for laparoscopic bariatric interventions, but which uses basic and significant changes to ERAS – low-invasiveness and multimodality.Materials and methods. We performed a single-institution retrospective analysis in patients who underwent laparoscopic bariatric interventions from 2011 to 2018. Patients were stratified into ERAS protocol group (n1=44) andstandard care group ( n2=24). Primary endpoints of efficacy – during the first 24 hours after surgery, the need for anesthetizing analgesics, the absence of need for staying in emergency department, the absence of episodes of PONV, mobilization and the onset of enteral fluid intake. The secondary result is a reduction in the length of stay in a hospital.Results.During the first 24 hours after surgery, the needof emergency department visits, the frequency of episodes of PONV were statistically lower in the ERAS group. The frequency of analgesia with narcotic analgesics was almost 2 times higher in the standard care group (58.3 vs. 30%, p = 0.05). In the course of the first post-operative day, all patients in the ERAS group were mobilized. Median hospital stay was significantly shorter in the ERAS group compared to the standard care group(4.4 ± 0.15 vs. 5.3 ± 0.26, p <0.01).Conclusion.The introduction of the modified ERAS protocol during laparoscopic bariatric interventions has significantly reduced the opioid load and shortened the duration of stay in the hospital.