ERAS in Bariatric Surgery: Kuwait’s First Program (2022)

Enhanced Recovery After Surgery (ERAS) in Bariatric Surgery Kuwait’s first ERAS protocol for obesity surgery, implemented in 2022 By: Professor Mohammad Jamal MBChB(HONS) MEd FRCSC FACS DABS FASMBS FABOM Quick answer: Enhanced Recovery After Surgery (ERAS) is an evidence-based care pathway that reduces the physical stress of surgery so patients recover faster. In bariatric surgery it combines shorter fasting, carbohydrate loading, opioid-sparing pain control, protective anesthesia, early walking, and early fluid intake. It typically shortens hospital stay to 24 to 48 hours without increasing complications. I introduced and applied the first ERAS protocol for obesity surgery in Kuwait in 2022. What Is Enhanced Recovery After Surgery? For most of surgical history, recovery was something that happened to the patient. Long fasting, bed rest, strong opioids, and days of waiting were treated as unavoidable. Enhanced Recovery After Surgery, known worldwide as ERAS, replaced that tradition with something measurable: a bundle of around twenty evidence-based steps applied before, during, and after the operation, each one designed to blunt the body’s stress response to surgery. The ERAS Society published dedicated guidelines for bariatric surgery in 2016 and updated them in 2021. The principle is simple. Surgery is a controlled injury, and the faster the body’s metabolism returns to normal, the fewer complications occur. A First for Kuwait: ERAS in Obesity Surgery Since 2022 In 2022 I implemented the first Enhanced Recovery After Surgery protocol for bariatric and metabolic surgery in Kuwait Building the program required more than a document. It meant retraining nursing teams, aligning anesthesia colleagues around opioid-sparing techniques, redesigning preoperative counseling, and convincing patients and families that walking on the evening of surgery is safe and beneficial rather than reckless. Today that pathway is standard practice in my units, and average discharge occurs within 24 hours. Before Surgery: Preparation Begins Weeks Ahead ERAS starts long before the operating room. Patients receive structured education so they know exactly what each day will look like, which reduces anxiety and improves compliance. Smoking cessation, optimization of diabetes and sleep apnea, and a preoperative liver-shrinking diet all reduce technical difficulty and risk. Prolonged fasting is abandoned: clear fluids are allowed until two hours before anesthesia, and a carbohydrate drink beforehand prevents the insulin resistance that fuels fatigue and nausea. During Surgery: Precision and Protection Inside theater, the protocol focuses on maintaining normal physiology. That means careful temperature control, goal-directed fluid therapy that avoids both dehydration and fluid overload, aggressive prevention of nausea and vomiting with multiple agents, thromboprophylaxis, low-pressure laparoscopy where feasible, and multimodal analgesia including local anesthetic blocks so that opioids become a rescue option rather than a routine. After Surgery: Movement, Fluids, Early Discharge The final phase is the most visible to patients. Drains and urinary catheters are avoided unless specifically indicated. Patients sit up and walk within hours, begin sipping clear fluids on the same day, and continue scheduled paracetamol and anti-inflammatory cover instead of waiting for pain to build. Discharge criteria are objective, and structured follow-up by phone and clinic ensures that leaving early never means leaving unsupported. What the Evidence Shows Published series and meta-analyses in bariatric populations consistently report roughly one day less in hospital, lower rates of nausea, less opioid consumption, faster return to work, and readmission rates that are equal to or lower than conventional care. Patient satisfaction rises sharply, largely because expectations are set clearly and met. Is ERAS Right for Every Patient? Most patients qualify. Those with severe cardiopulmonary disease, complex revisional anatomy, or limited home support may need a longer stay, and the protocol is designed to flex around them rather than force them into a timeline.

Frequently Asked Questions How long is the hospital stay after bariatric surgery or gallbladder surgery with ERAS? Most patients are discharged within 24 to 48 hours, compared with three to five days under traditional care. Is early discharge safe after sleeve gastrectomy? Yes, when objective discharge criteria and structured follow-up are used. Studies show readmission rates are not increased. Does ERAS mean less pain medication? It means fewer opioids, not less pain relief. Scheduled non-opioid analgesia and local blocks control pain with fewer side effects. When can I walk after obesity surgery? Usually within a few hours of the operation, on the same day. Who introduced ERAS for obesity surgery in Kuwait? The first ERAS protocol for bariatric and metabolic surgery in Kuwait was implemented in 2022 as described in this article.