Feasibility and Outcomes of a Uniform Drain-Free Strategy for Primary and Revisional Metabolic Bariatric Surgery under an ERAS Protocol.

INTRODUCTION

Routine prophylactic drainage in metabolic bariatric surgery remains controversial, with limited evidence of clinical benefit, even in higher-risk procedures. Real-world data on a uniform drain-free strategy within enhanced recovery after surgery (ERAS) pathways are scarce. We assessed the feasibility of a uniform drain-free approach in primary and revisional metabolic bariatric surgery and its short-term outcomes.

METHODS

We retrospectively reviewed 1,122 consecutive laparoscopic metabolic bariatric procedures performed by a single high-volume surgeon (2018–2024). No patients, including those undergoing revisional surgery, received prophylactic abdominal drains. Postoperative care followed a standardized ERAS protocol incorporating structured bedside assessment, serial biomarker monitoring, and criteria-driven imaging. Outcomes included major complications, transfusion, reoperation, postoperative length of stay (LOS), and 30-day readmission.

RESULTS

The cohort was 51.2% female, with a median age of 38 years and median body mass index of 37.8 kg/m². Overall 30-day morbidity was 3.2%, with most major events diagnosed after the typical drain-removal window and often beyond postoperative day 1. Anastomotic leakage occurred in five patients (0.4%; median 43 h) and was surgically repaired without ICU admission or residual abscess. Overt gastrointestinal bleeding occurred in 13 patients (1.2%); eight required readmission and six transfusion, all managed without hemodynamic instability, endoscopy, ICU admission, or reoperation. More than 92% of patients were discharged on postoperative day 1. Outcomes remained favorable in higher-risk and revisional procedures.

CONCLUSIONS

A uniform drain-free strategy is feasible in primary and revisional metabolic bariatric surgery within a standardized ERAS pathway, with low short-term morbidity and efficient early recovery.