Extremely Early Ambulation after Bariatric and Metabolic Surgery: A Randomized Controlled Trial

Area of Science:

• Bariatric Surgery
• Surgical Recovery
• Gastrointestinal Physiology

Background:

• Postoperative gastrointestinal dysfunction (POGD) is a frequent complication following metabolic bariatric surgery (MBS).
• Current Enhanced Recovery After Surgery (ERAS) guidelines suggest ambulation on postoperative day one, but evidence for very early mobilization in the post-anesthesia care unit (PACU) is limited.

Purpose of the Study:

• To determine if a structured, graded ambulation protocol initiated in the PACU can reduce the time to first flatus after laparoscopic sleeve gastrectomy (LSG).
• To assess the protocol's impact on recovery quality and safety, including adverse events.

Main Methods:

• A single-center, assessor-blinded, randomized controlled trial involving 92 patients undergoing elective LSG.
• Patients were randomized to either a PACU ambulation group (experimental) or conventional ward ambulation group (control).
• The experimental group followed a 3-step protocol (sitting, standing, walking) starting in the PACU; primary outcome was time to first flatus.

Main Results:

• The PACU ambulation group experienced a significantly shorter time to first flatus (median 18.6h vs. 24.0h, P<0.001).
• Quality of Recovery-15 (QoR-15) scores were significantly higher in the experimental group on postoperative days 0, 1, and 2.
• No significant differences in adverse events like postoperative nausea and vomiting (PONV) or orthostatic hypotension were observed between groups.

Conclusions:

• A structured, graded ambulation protocol initiated in the PACU is safe and effective in accelerating gastrointestinal recovery after LSG.
• This early mobilization strategy improves overall recovery quality and supports integration into ERAS pathways for MBS patients.