Background

Post-pandemic access to operative room was restricted. Using our large experience in same-day discharge (SDD) sleeve gastrectomy, we extended this management to hypoabsorptive metabolic procedures.OBJECTIVESTo analyse retrospectively the early outcomes (<=30 days) of malabsorptive surgeries with planned SDD (<=12h).

Methods

Strict pre-operative criteria, enhanced recovery after bariatric surgery protocol and modified Post-Anesthesia Care Unit (PACU) criteria were applied. Hypoabsorptive procedures included Single Anastomosis Duodeno-Ileal Bypass (SADI-S), Roux-en-Y Gastric Bypass (RYGB), One-Anastomosis Gastric Bypass (OAGB) and Single Anastomosis Sleeve Ileal bypass (SASI). Unplanned overnight stay, emergency department (ED) visit, rehospitalization, morbi-mortality and reintervention rates were detailed.

Results

Since 2021, 208 patients experienced SDD malabsorptive procedures (191F/17M, mean age=41.4yo, mean preoperative BMI=41.9kg/m2)92 SADI-S, 72 RYGB, 35 OAGB and 9 SASI. Revision surgeries account for 76% of cases. Unplanned overnight stay and ED visit rate were both 4.3%. Rehospitalization rate was 6.25% (6 SADI-S, 5 RYGB, 1 OAGB and 1 SASI). Morbidity rate was 13.5%, including 3.8% major complications. For SADI-S-group, there were 2 duodenal leaks, 1 appendicitis, 1 intrabdominal abscess, and 1 commun bile duct stenosis. In the RYGB-group, there was 2 occlusions on the jejuno-jejunal anastomosis and 1 gastro-jejunal anastomosis bleeding. Only 5 of them required reintervention (2.4%). There was no Dindo-Clavien grade IV and no mortality.

Conclusions

In our experience rates of unplanned overnight stay, readmission and reintervention were low and acceptable. Early outcomes suggest that SDD hypoabsorptive metabolic surgery seems safe and feasible in experimented teams with hyperselective criteria and appropriate post-operative follow-up