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Introduction <p>Routine prophylactic drainage in metabolic bariatric surgery remains controversial, with limited evidence of clinical benefit, even in higher-risk procedures. Real-world data on a uniform drain-free strategy within enhanced recovery after surgery (ERAS) pathways are scarce. We assessed the feasibility of a uniform drain-free approach in primary and revisional metabolic bariatric surgery and its short-term outcomes.</p> Methods <p>We retrospectively reviewed 1,122 consecutive laparoscopic metabolic bariatric procedures performed by a single high-volume surgeon (2018–2024). No patients, including those undergoing revisional surgery, received prophylactic abdominal drains. Postoperative care followed a standardized ERAS protocol incorporating structured bedside assessment, serial biomarker monitoring, and criteria-driven imaging. Outcomes included major complications, transfusion, reoperation, postoperative length of stay (LOS), and 30-day readmission.</p> Results <p>The cohort was 51.2% female, with a median age of 38 years and median body mass index of 37.8&#xa0;kg/m². Overall 30-day morbidity was 3.2%, with most major events diagnosed after the typical drain-removal window and often beyond postoperative day 1. Anastomotic leakage occurred in five patients (0.4%; median 43&#xa0;h) and was surgically repaired without ICU admission or residual abscess. Overt gastrointestinal bleeding occurred in 13 patients (1.2%); eight required readmission and six transfusion, all managed without hemodynamic instability, endoscopy, ICU admission, or reoperation. More than 92% of patients were discharged on postoperative day 1. Outcomes remained favorable in higher-risk and revisional procedures.</p> Conclusions <p>A uniform drain-free strategy is feasible in primary and revisional metabolic bariatric surgery within a standardized ERAS pathway, with low short-term morbidity and efficient early recovery.</p>

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Feasibility and Outcomes of a Uniform Drain-Free Strategy for Primary and Revisional Metabolic Bariatric Surgery under an ERAS Protocol

  • 期刊论文

  • 发表日期：

    2026年4月13日

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  • Shih-Chang Hsu,
  • Pei-Song Gao,
  • Hung-Chieh Lo

摘要

Introduction

Routine prophylactic drainage in metabolic bariatric surgery remains controversial, with limited evidence of clinical benefit, even in higher-risk procedures. Real-world data on a uniform drain-free strategy within enhanced recovery after surgery (ERAS) pathways are scarce. We assessed the feasibility of a uniform drain-free approach in primary and revisional metabolic bariatric surgery and its short-term outcomes.

Methods

We retrospectively reviewed 1,122 consecutive laparoscopic metabolic bariatric procedures performed by a single high-volume surgeon (2018–2024). No patients, including those undergoing revisional surgery, received prophylactic abdominal drains. Postoperative care followed a standardized ERAS protocol incorporating structured bedside assessment, serial biomarker monitoring, and criteria-driven imaging. Outcomes included major complications, transfusion, reoperation, postoperative length of stay (LOS), and 30-day readmission.

Results

The cohort was 51.2% female, with a median age of 38 years and median body mass index of 37.8 kg/m². Overall 30-day morbidity was 3.2%, with most major events diagnosed after the typical drain-removal window and often beyond postoperative day 1. Anastomotic leakage occurred in five patients (0.4%; median 43 h) and was surgically repaired without ICU admission or residual abscess. Overt gastrointestinal bleeding occurred in 13 patients (1.2%); eight required readmission and six transfusion, all managed without hemodynamic instability, endoscopy, ICU admission, or reoperation. More than 92% of patients were discharged on postoperative day 1. Outcomes remained favorable in higher-risk and revisional procedures.

Conclusions

A uniform drain-free strategy is feasible in primary and revisional metabolic bariatric surgery within a standardized ERAS pathway, with low short-term morbidity and efficient early recovery.