Study design
nausea, bleeding, intraoperative bleeding, tachycardia, fever, epigastric pain, purulent, Bleeding
BLEEDING, OBESE, SURGICAL COMPLICATIONS, LEAKAGE, BLEEDING, INTRAOPERATIVE BLEEDING
A double-blind (patient, postoperative data collector, and statistician),
randomized controlled prospective study on class III morbidly obese patients
matched for body mass index (BMI) and comorbidities was conducted in a tertiary
education and research hospital between January 2022 and February 2023. The
study was approved by the ethics committee of the University of Medeniyet
(decision no. 2021/0530, dated August 12, 2021), and the trial was registered at
Patients were randomly classified into two groups: T0 (patients who did not wait)
and T1 (patients who waited). The patients underwent preoperative,
intraoperative, and postoperative interventions based on the principles of
multimodal enhanced recovery bariatric surgery (ERABS).The patients underwent preoperative, intraoperative, and postoperative
interventions according to the principles of multimodal enhanced recovery
bariatric surgery (ERABS). Antithrombotic prophylaxis with enoxaparin was
administered until postoperative day 14, and all the patients were followed up
based on our routine enhanced recovery protocol, including oral intake beginning
on postoperative day 1 and discharge planned on postoperative day 2.Discharge Criteria:AnamnesisVisual analogue score < 4No complaints of nausea or vomitingOral fluid intake > 1,500 ml in 24 hoursMoving and walking independently without supportNo complaints of leg painPhysical ExaminationAbdominal examination is normalBody fever < 38°CPulse rate < 100 bpmOxygen saturation (SatO2) > %95Respiration rate: 10–16Drainage < 50 mlLaboratory ResultsPostoperative hemoglobin decline < 2.0 g/dLWhite blood cell (WBC) < 12 × 10^3/uLC-reactive protein (CRP) < 20 mg/dLPostoperative follow-up data were recorded by nursing staff and physicians’
assistants who were blinded to the procedures. Our prospective database included
the documentation of all medical and surgical complications. In this study,
intraoperative parameters, such as leakage, bleeding, reoperation and mortality
rates, operative time, number of stapler shots, intraoperative bleeding, number
of bleeding points treated with clips on the stapler line, and amount of blood
in the aspirator and gauze, were recorded. Laboratory tests were requested from
the patients on postoperative days 1, 7, and 30. Bleeding was defined as
hemoglobin > 2 g/dL, pure blood drainage > 100 ml, or serohemorrhagic
drainage > 200 ml and standing blood pressure < 20 mmHg. Parameters for
leaks included purulent drainage from the drain, fever, tachycardia, increased
respiratory rate, and severe epigastric pain.