As obesity rates across the globe continue to rise, medical professionals are exploring innovative approaches to weight loss surgery. Recently, a notable shift has been seen in the realm of bariatric surgery, with the emergence of day-case laparoscopic sleeve gastrectomy (LSG) as a feasible option. A review of the literature, published in the journal “Surgery for Obesity and Related Diseases,” highlights the advancement of LSG from an inpatient to a day-case surgery procedure, marking a significant development within the medical community [DOI: 10.1016/j.soard.2019.03.020].
The review, led by Doctor Lionel Rebibo from the Department of Digestive, Esogastric and Bariatric Surgery at Bichat Claude Bernard University Hospital in France, along with his interdisciplinary team, shines light on this new avenue in managing morbid obesity. With 6227 patients included in the six studies analyzed, the evidence points towards not only the feasibility of LSG as day-case surgery (DCS) but also its reliability and safety when managed appropriately.
The Emergence of LSG as a Day-Case Surgery
Traditionally, bariatric surgeries, such as LSG, were performed under inpatient settings due to their complexity and the need for postoperative monitoring. However, advancements in surgical techniques and perioperative care have enabled certain procedures to shift to a day-case format, where patients are discharged on the same day of the surgery. This is particularly advantageous as it potentially reduces healthcare costs, minimizes the risk of hospital-acquired infections, and is more convenient for patients.
Laparoscopic sleeve gastrectomy has recently become one of the most popular bariatric procedures, thanks to its standardized and reproducible nature, coupled with a short operating time and straightforward perioperative management. Given these characteristics, the procedure is an ideal candidate for the DCS setting.
Criteria and Risk Management for DCS Procedures
The transition of LSG to a day-case procedure demands meticulous patient selection and risk management strategies. The inclusion criteria for patients to qualify for DCS are crucial and were found to be uniform across most studies analyzed. They typically include primary sleeve gastrectomy candidates with a body mass index (BMI) of ≥40 kg/m². Contraindications are carefully considered to ensure patient safety.
Risk management is an integral aspect of DCS. The studies review devoted significant attention to the provision of clear guidelines for the prevention and management of potential complications. Preoperative assessments, intraoperative monitoring, and well-defined postoperative care pathways are cornerstones for successfully executing LSG as a DCS procedure.
The Feasibility and Results of LSG as DCS
The literature review published indicates that day-case LSG is not only possible but also efficient. Most published series regarding LSG as DCS were retrospective and single-centered, indicating a need for more rigorous research designs such as randomized controlled trials. However, the results so far are promising. They include short-term outcomes like low complication rates, high patient satisfaction scores, and reduced overall costs.
It is also noted that the use of enhanced recovery after surgery (ERAS) protocols has facilitated the implementation of LSG in the DCS setting. Such protocols include minimizing the length of the hospital stay, reducing perioperative stress responses, and optimizing patient outcomes.
The Path Forward: Challenges and Considerations
While the literature review presents an optimistic view of LSG as a day-case surgery, challenges remain. There are concerns related to the potential risks associated with the rapid discharge of patients, such as the management of postoperative pain, nausea, and the risk for late-onset complications which might necessitate readmission.
Moreover, the long-term results of day-case LSG are still pending, and further research is needed to validate the outcomes compared to the traditional inpatient approach. Factors such as the weight loss sustainability and the quality of life improvements must be systematically assessed to fully understand the implications of this shift in practice.
Conclusion
The review by Dr. Rebibo and his colleagues represents a paradigm shift in the management of morbid obesity, with laparoscopic sleeve gastrectomy taking a revolutionary leap from the inpatient to the outpatient setting. The day-case approach to LSG shows great promise, with evidence pointing towards its viability, safety, and cost-effectiveness.
The adoption of day-case LSG could revolutionize bariatric surgery, offering patients an efficient and less burdensome alternative to conventional methods. Healthcare systems considering this surgical innovation must take into account proper patient selection, meticulous risk management, and the establishment of robust postoperative support systems.
This expansion in the surgical offerings showcases the agility of modern healthcare in adapting to new challenges and innovations. As the body of evidence grows, we may observe an increasing number of weight loss surgeries being successfully managed on a day-case basis, thus transforming the patient experience and enhancing the healthcare delivery model.
References
1. Rebibo, L., Maurice, K. K., Nimier, M., Ben Rehouma, M., Montravers, P., & Msika, S. (2019). Laparoscopic sleeve gastrectomy as day-case surgery: a review of the literature. Surgery for Obesity and Related Diseases, 15(7), 1211–1217. https://doi.org/10.1016/j.soard.2019.03.020
2. Surgery for Obesity and Related Diseases – Journal Homepage. (n.d.). Retrieved from https://www.soard.org/
3. The American Society for Bariatric Surgery: The Vision and Goals. (n.d.). Retrieved from https://asmbs.org/
4. Rosenthal, R. J. (2018). The International Federation for Surgery of Obesity and Metabolic Disorders’ Position Statement on Optimizing Outcomes for Day-Case Bariatric Surgery. Obesity Surgery, 28(7), 1878–1887. DOI: 10.1007/s11695-018-3200-8
5. DeMaria, E. J., Portenier, D., & Wolfe, L. (2007). Obesity Surgery Mortality Risk Score: Proposal for a Clinically Useful Score to Predict Mortality Risk in Patients Undergoing Gastric Bypass. Surgery for Obesity and Related Diseases, 3(2), 134–140. DOI: 10.1016/j.soard.2007.01.005
Keywords
1. Day-case laparoscopic sleeve gastrectomy
2. Bariatric surgery advancement
3. Sleeve gastrectomy outpatient
4. Minimally invasive weight loss surgery
5. Bariatric day-case procedures