Anastomotic metabolic and bariatric surgeries with same-day discharge: 30-day outcomes of a cohort from a high-volume center in Canada

• Published in: Surgery for obesity and related diseases
• Main Authors: Deffain, Alexis, Denis, Ronald, Alfaris, Heba, Ataya, Karim, Melebari, Samah, Belliveau, Marc, Di Palma, Adam, Garneau, Pierre Y., Studer, Anne-Sophie
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 16-08-2024
• Subjects: Ambulatory surgery; Anastomotic bariatric surgeries; ERABS protocols; Obesity epidemic; Same-day discharge (SDD); ERABS protocols; Ambulatory surgery; Obesity epidemic; Same-day discharge (SDD); Anastomotic bariatric surgeries
• ISSN: 1550-7289; 1878-7533; 1878-7533
• DOI: 10.1016/j.soard.2024.08.020

On the basis of our extensive experience in same-day discharge (SDD) sleeve gastrectomy, we extended this management strategy to anastomotic metabolic and bariatric surgeries (MBS).
To retrospectively analyze early outcomes (≤30 d) after anastomotic MBS with planned SDD (≤12 hr).
University Hospital, Canada; Public Practice.
SDD anastomotic MBS were proposed with strict preoperative criteria and included single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and single-anastomosis sleeve ileal bypass (SASI). Enhanced recovery after bariatric surgery protocols and post-anesthesia care unit criteria were followed. Unplanned overnight stay, emergency department (ED) visit, readmission, morbidity-mortality, and reintervention rates were analyzed.
Since 2021, 208 patients (191 female and 17 male) have undergone SDD anastomotic MBS, with 76% conversion procedures: 92 SADI-S, 72 RYGB, 35 OAGB, and 9 SASI (mean age = 41.4 yr and mean preoperative body mass index = 41.9 kg/m2). Unplanned overnight stays and ED visits were 4.8% and 4.3%, respectively. Readmission rate was 5.8% (5 SADI-S, 5 RYGB, 1 OAGB, and 1 SASI). Overall morbidity rate was 14.9%, including 3.9% major complications. Within 30 days postoperatively, there were 2 duodenal leaks, 1 intrabdominal collection, 1 common bile duct stenosis, and 1 acute appendicitis in the SADI-S group. There were 2 occlusions on the jejunojejunal anastomosis and 1 bleeding on the gastrojejunal anastomosis in the RYGB group. Five (2.4%) required reintervention with no mortality.
We report low and acceptable rates of unplanned overnight stay, readmission, and reintervention. Early outcomes suggest that SDD anastomotic MBS seems safe and feasible with an experienced team, selective criteria, and appropriate postoperative follow-up.
•Codified strategy for same-day discharge (SDD) anastomotic metabolic and bariatric surgeries (MBS) contributes to favorable early outcomes.•To obtain SDD management, patient selection criteria must be strictly adhered to.•SDD seems feasible for anastomotic MBS if performed at a high-volume center.•SDD management expands access to surgical care in the era of enhanced recovery after bariatric surgery.