Anonymous User
Login / Registration

a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2023; 77(6): 509–523. doi: 10.48095/ccgh2023509.

Practical clinical recommendations for perioperative care in bariatric surgery 2023: adaptation of ERAS (Enhanced Recovery After Surgery) recommendations with consensual voting of working group of Joint Section of Bariatric and Metabolic Surgery of Czech

Igor Satinský  1, Martin Hrubý2, Petra Šrámková3, Jiří Patka4, Michal Čierný5, P. Babiak6, Igor Šimoník7, Peter Schwarz8, Martin Haluzík  9,10

+ Affiliation


Introduction: Bariatric surgery is the most effective treatment for the morbid obesity. It results in sustained weight loss as well as pronounced effects on obesity-related comorbidities. In the last twenty years the number of procedures performed worldwide increased. Therefore, the effort to establish a consensus in perioperative care based on best evidence in this issue is evident. Methods: Working Group of Joint Section of Bariatric and Metabolic Surgery of Czech Surgery Society and Czech Obesitology Society reached practical recommendations for ERAS (Enhanced Recovery After Surgery) in perioperative care in bariatric surgery. It issued from ERAS recommendations published in 2021. Working group adopted the original text, consequently adapted and in particular cases affixed its commentary. The electronic voting of all members of working group was the final phase, by which the strength of consensus of particular elements was expressed. Results: The Czech working group reached the consensus with recommendations ERABS (Enhanced Recovery After Bariatric Surgery) in the most elements. For some interventions of ERAS protocol for bariatric surgery the quality of evidence is low. Therefore, evidence-based practices may need to be extrapolated from other surgeries. Conclusion: The recommendation is appointed for clinical practice in bariatric surgery with protocol ERAS based on updated evidence and recommendations. It is based on recent and comprehensive ERAS recommendation, which was adopted and adapted by the Czech working group of Joint Section of Bariatric and Metabolic Surgery of Czech Surgery Society and Czech Obesitology Society. The Czech version contents some supplementations and specifications in commentaries. Original article was published in Rozhledy v chirurgii [1].


bariatric and metabolic surgery, Enhanced Recovery After Surgery, practical clinical recommendations

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users


1. Satinský I, Hrubý M, Šrámková P et al. Praktické klinické doporučení pro perioperační péči v bariatrické chirurgii 2023. Rozh Chir 2023; 102(7): 283–297. doi: 10.33699/PIS2023.102.7.283-297.
2. Angrisani L, Santonicola A, Iovino P et al. IFSO Worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg 2018; 28(12): 3783–3794. doi: 10.1007/s11695-018-3450-2.
3. Parisi A, Desiderio J, Cirocchi R et al. Enhanced recovery after surgery (ERAS): a systematic review of randomised controlled trials (RCTs) in bariatric surgery. Obes Surg 2020; 30(12): 5071–5085. doi: 10.1007/s11695-020-05000-6.
4. Geubbels N, Evren I, Acherman YIZ et al. Randomized clinical trial of an enhanced recovery after surgery programme versus conventional care in laparoscopic Roux-en-Y gastric bypass surgery. BJS Open 2019; 3(3): 274–281. doi: 10.1002/bjs5.50143.
5. Thorell A, MacCormick AD, Awad S et al. Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg 2016; 40(9): 2065–2083. doi: 10.1007/s00 268-016-3492-3.
6. Stenberg E,  Falcão LF, O‘Kane M et al. Guidelines for Perioperative Care in Bariatric Surgery: Enhances Recovery After Surgery (ERAS) Society Recommandations: A 2021 Update. World J Surg 2022;  46(4): 729–751. doi:   10.1007/s00268-021-06394-9.e.
7. Guyatt GH, Oxman AD, Kunz R et al. Going from evidence to recommendations. BMJ 2008; 336(7652): 1049–1051. doi: 10.1136/bmj.39493. 646875.AE.
8. Guyatt GH, Oxman AD, Kunz R et al. What is „quality of evidence“ and why is it important to clinicians? BMJ 2008; 336(7651): 995–998. doi: 10.1136/bmj.39490.551019.BE.
9. German Association of the Scientific Medical Societies (AWMF) – Standing Guidelines Commission. AWMF guideline manual and rules for guideline development. 2012 [online]. Dostupné z: https: //
10. Mechanick JI, Apovian C, Brethauer S et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by american association of clinical endocrinologists/American college of endocrinology, the obesity society, american society for metabolic & bariatric surgery, obesity medicine association, and american society of anesthesiologists – executive sum- mary. Endocr Pract 2019; 25(12): 1346–1359. doi: 10.4158/GL-2019-0406.
11. NIH conference (1991) Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 1991; 115(12): 956–961.
12. NICE. Obesity: identification, assessment and management. 2014 [online]. Dostupné z:
13. Rubino F, Nathan DM, Eckel RH et al. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care 2016; 39(6): 861–877. doi: 10.2337/dc16-0236.
14. Eisenberg D, Shikora SA, Aarts E et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 2022; 18(12): 1345–1356. doi: 10.1016/j.soard.2022.08.013.
15. Šrámková P, Fried M. Antiobezitika před bariatrickou operací a po ní – jak je využít co nejlépe. Čas Lék čes 2022; 161(3–4): 107–113.
16. Hughes MJ, Hackney RJ, Lamb PJ et al. Prehabilitation before major abdominal surgery: a systematic review and meta-analysis. World J Surg 2019; 43(7): 1661–1668. doi: 10.1007/s00268-019-04950-y.
17. Singh PP, Srinivasa S, Lemanu DP et al. Statins in abdominal surgery: a systematic review. J Am Coll Surg 2012; 214(3): 356–366. doi: 10.1016/j.jamcollsurg.2011.11.008.
18. Ljungqvist O, Jonathan E. Rhoads lecture 2011: Insulin resistance and enhanced recovery after surgery. JPEN J Parenter Enteral Nutr 2012; 36(4): 389–398. doi: 10.1177/0148 607112445580.
19. Gan TJ, Belani KG, Bergese S et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2020; 131(2): 411–448. doi: 10.1213/ANE.0000000000004833.
20. Bamgbade OA, Oluwole O, Khaw RR. Perioperative antiemetic therapy for fast-track laparoscopic bariatric surgery. Obes Surg 2018; 28(5): 1296–1301. doi: 10.1007/s11695-017-3009-7.
21. Reiterer C, Kabon B, Zotti O et al. Effect of goal-directed crystalloid – versus colloid-based fluid strategy on tissue oxygen tension: a randomised controlled trial. Br J Anaesth 2019; 123(6): 768–776. doi: 10.1016/j.bja.2019.08.027. 
22. Gero D, Raptis DA, Vleeschouwers W et al. Defining global benchmarks in bariatric surgery: a retrospective multicenter analysis of minimally invasive roux-en-y gastric bypass and sleeve gastrectomy. Ann Surg 2019; 270(5): 859–867. doi: 10.1097/SLA.0000000000003512.
23. Zevin B, Aggarwal R, Grantcharov TP. Volume-outcome association in bariatric surgery: a systematic review. Ann Surg 2012; 256(1): 60–71. doi: 10.1097/SLA.0b013e3182554c62.
24. Doumouras AG, Maeda A, Jackson TD. The role of routine abdominal drainage after bariatric surgery: a metabolic and bariatric surgery accreditation and quality improvement program study. Surg Obes Relat Dis 2017; 13(12): 1997–2003. doi: 10.1016/j.soard.2017.08.019.
25. Kakkos SK, Caprini JA, Geroulakos G et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev 2016; 9(9): CD005258. doi: 10.1002/14651858.CD005258.pub4.
26. Parrott J, Frank L, Rabena R et al. American society for metabolic and bariatric surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis 2017; 13(5): 727–741. doi: 10.1016/j.soard.2016.12.018.
27. O‘Kane M, Parretti HM, Pinkney J et al. British obesity and metabolic surgery society guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obes Rev 2020; 21(11): e13087. doi: 10.1111/obr.13087. 
28. Ying VW, Kim SH, Khan KJ et al. Prophylactic PPI help reduce marginal ulcers after gastric bypass surgery: a systematic review and meta-analysis of cohort studies. Surg Endosc 2015; 29(5): 1018–1023. doi: 10.1007/s00464-014-3794-1.
29. Haal S, Gurman MS, Boerlage TC et al. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicentre, double-blind, randomised, placebo-controlled superiority trial. Lancet Gastroenterol Hepatol 2021; 6(12): 993–1001. doi: 10.1016/S2468-1253(21)00301-0.
30. Tian YL, Cao SG, Liu XD et al. Short- and long-term outcomes associated with enhanced recovery after surgery protocol vs conventional management in patients undergoing laparoscopic gastrectomy. World J Gastroenterol 2020; 26(37): 5646–5660. doi: 10.3748/wjg.v26.i37.5646.
31. Gustafsson UO, Scott MJ, Hubner M et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS) society recommendations: 2018. World J Surg 2019; 43(3): 659–695. doi: 10.1007/s00268-018-4844-y.

Credited self-teaching test