Implementation OF Enhanced Recovery After Bariatric Surgery (ERABS) Protocol: Single-Center Experience of 470 Consecutive Laparoscopic Sleeve Gastrectomies and Separate Analysis for Different Volume Surgical Sessions.

BACKGROUND: This series presents a single-center experience with a standardized enhanced recovery after bariatric surgery (ERABS) protocol, reporting perioperative and short-term outcomes following primary laparoscopic sleeve gastrectomy (LSG). Additionally, a separate analysis of high-volume surgical sessions, consisting of either seven or eight patients, was performed to determine whether an increased caseload affects outcomes. METHODS: This is a single-center retrospective study reporting the short-term outcomes of 470 patients who underwent LSG at Humanitas Gavazzeni, Bergamo, from January 2024 to September 2025. Within the patient cohort, we further analyzed purely LSG surgical sessions of seven or eight patients, comparing perioperative outcomes and costs. RESULTS: The mean body mass index (BMI) was 42.2 ± 5.2 kg/m², the mean American Society of Anesthesiologists (ASA) score was 2.6 ± 0.5, and the mean Charlson Comorbidity Index (CCI) was 1.4 ± 1.5. The mean skin-to-skin operative time was 40.5 ± 10.2 min. The average length of hospital stay (LOS) was 2 ± 0.2 days. The rate of postoperative nausea and vomiting (PONV) was 4.7, whereas 3.6% of patients required morphine rescue therapy for intense pain. No major complications occurred. The 30-day readmission was 1.1%. The separate analysis among surgical sessions with seven versus eight patients did not show statistically significant differences. The main operating room costs were 4417.2 ± 403.3 euros for the seven-patient sessions and 4844 ± 211.3 euros for the eight-patient sessions. CONCLUSIONS: The finding of the present study demonstrates that adherence to ERABS principles can facilitate safe, efficient, and cost-effective care in high-volume bariatric centers. However, the study’s limitations, including its retrospective nature and the limited analysis to only one surgical procedure, may not accurately reflect the real impact of enhanced recovery protocols in bariatric surgery.