Fast Track Surgery
Fast Track Surgery
Due to the increasing incidence of morbid obesity, the demand for obesity surgery is on the rise, as no other treatment method can achieve significant and permanent weight loss. Therefore, techniques for improving obesity surgery have become more diverse to improve surgical results and increase their effectiveness. Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant in Bariatric Surgery at Kasr El-Ainy Faculty of Medicine, was interested in applying a new technique for the first time in the Middle East. Fast Track Surgery, also known as Enhanced Recovery after Surgery, is a modern technique that aims to expedite the recovery process and facilitate a prompt return to work and mobility following bariatric surgery, without drains or catheters. Other surgeries can also apply this technique.
Fast Track Surgery focuses on the patient with the goal of rapid recovery and guaranteed weight loss. Multiple elements, such as appropriate patient selection, pre-surgical preparation, minimally invasive surgery, an experienced team, and postoperative follow-up achieve these goals. All these elements reduce surgical stress, making bariatric surgery rapid in recovery, effective, and safe. When the Fast Track Surgery is completed properly, the patient is discharged on the same day of the surgery. The Fast Track Surgery technique represents a real opportunity to enhance postoperative recovery in obese patients and reduce complication rates.
The idea of Fast Track Surgery:
Bariatric surgery is considered an effective and acceptable treatment for obesity and its associated diseases. In recent years, there has been continuous development with the introduction of many innovations, either in surgical techniques or in anesthesia methods, towards less invasive treatment to facilitate recovery and improve the outcomes of various bariatric surgeries, such as sleeve gastrectomy and bypass, without compromising patient safety.
It has been found that many of the techniques used in abdominal surgery, such as the routine use of drainage and urinary catheterization, are unnecessary or even harmful. On the other hand, minimally invasive surgery, especially the use of laparoscopic techniques, has proven to be safe and achieves rapid recovery. Due to these improvements and the increasing demand for bariatric surgery, prolonged hospital stay is no longer justified, and this is where the idea and importance of Fast Track Surgery has emerged.
"Fast Track Surgery" primarily deals with patient pain and length of hospital stay through various techniques, aiming to reduce postoperative dysfunction, improve recovery, and reduce complications.
Three Stages of Fast Track Surgery:
This technique includes three stages: the preoperative stage, the intraoperative stage, and the postoperative/recovery stage. These stages are equally important and work coordinately to accelerate surgical recovery.
Preoperative Stage of Fast Track Surgery:
• You don't need to fast for a long time before the surgery, but you should refrain from eating for only 6 hours. Dr. Ahmed Abd El Salam limits the duration of abstaining from clear fluids to two hours.
• In the past, it was customary to fast for long periods, up to 12 hours, which led to body fatigue and dehydration.
• Hospital admission occurs on the day of surgery, and the person does not need to stay overnight before the procedure.
• Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant in Bariatric Surgery at Kasr El-Ainy Faculty of Medicine, also focuses in this stage on controlling the medical conditions associated with obesity, such as heart disease and diabetes. He also recommends quitting smoking at least 4 weeks before the surgery to reduce risks and wound healing problems.
• Dr. Ahmed Abd El Salam also educates the patient by providing detailed information and clear explanations about the expected postoperative course, pain medication, dietary program, and the expected discharge time from the hospital. This information reduces the patient's anxiety and need for pain medication, as well as motivates him to adhere to the plan, thereby accelerating the healing process and shortening his hospital stay.
During the Fast Track Surgery:
• Only specific and rare situations, such as patients taking blood thinners or those prone to bleeding, can use drains. Dr. Ahmed Abd El Salam restricts the use of drains to these groups to avoid their drawbacks and problems, such as obstruction and infection, which could cause more harm than benefit. Not using drains allows the patient to move quickly and without pain.
• A urinary catheter is not inserted nor needed, as patients start moving just 2 hours after the procedure.
• Minimally invasive surgical techniques, such as laparoscopy, eliminate the need for large surgical incisions, resulting in fewer complications, less post-surgical pain, and faster recovery.
Postoperative Stage of Fast Track Surgery:
The postoperative phase starts in the recovery room and continues until the patient returns to his normal level of functioning. During this period, the following steps are followed:
• On the day of surgery, a multimodal analgesia (MMA) approach keeps pain levels under control. This involves using a combination of analgesics, NSAIDs, paracetamol, and intravenous anesthetics to achieve the desired pain relief with fewer side effects associated with higher doses of a single medication; this also ensures faster recovery from anesthesia, improving patient recovery and leading to earlier mobilization and discharge.
• As soon as the anesthetic effects wear off, the medical team encourages patients to walk several times and get out of bed at least once every hour.
• Fluids are started within 2 hours after surgery, rather than waiting for gas passage or 24 hours, as previously done.
• The patient resumes solid food intake after 1 week, eliminating the need to wait 2 weeks for stomach healing, which could lead to muscle breakdown. Protein intake also starts after 10 days, such as eggs, fish, and liver, ensuring healthy weight loss by preserving muscle mass.
Bariatric surgeries using the Fast Track technique are gaining widespread acceptance because they are associated with the following:
• Faster recovery compared to traditional care for obese patients.
• Better surgical outcomes.
• Reduced complication rates.
• Shorter hospital stays (from hospital admission to meeting pre-defined discharge criteria).
• Ease of preparation for surgery, fasting for 2 hours for clear fluids and 6 hours for solid foods before surgery.
• Early mobilization and return to oral feeding.
• Reduced number of days off work.
It is known that the surgeon's experience and skill are the most important factors for patient safety and good results. As a result, you will lose your excess weight with a rapid recovery and without catheters or drains, with Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant in Bariatric Surgery at Kasr El-Ainy Faculty of Medicine, who is committed to applying the Fast Track Surgery technique to his patients for the first time in the Middle East.
Fast Track Surgery focuses on the patient with the goal of rapid recovery and guaranteed weight loss. Multiple elements, such as appropriate patient selection, pre-surgical preparation, minimally invasive surgery, an experienced team, and postoperative follow-up achieve these goals. All these elements reduce surgical stress, making bariatric surgery rapid in recovery, effective, and safe. When the Fast Track Surgery is completed properly, the patient is discharged on the same day of the surgery. The Fast Track Surgery technique represents a real opportunity to enhance postoperative recovery in obese patients and reduce complication rates.
The idea of Fast Track Surgery:
Bariatric surgery is considered an effective and acceptable treatment for obesity and its associated diseases. In recent years, there has been continuous development with the introduction of many innovations, either in surgical techniques or in anesthesia methods, towards less invasive treatment to facilitate recovery and improve the outcomes of various bariatric surgeries, such as sleeve gastrectomy and bypass, without compromising patient safety.
It has been found that many of the techniques used in abdominal surgery, such as the routine use of drainage and urinary catheterization, are unnecessary or even harmful. On the other hand, minimally invasive surgery, especially the use of laparoscopic techniques, has proven to be safe and achieves rapid recovery. Due to these improvements and the increasing demand for bariatric surgery, prolonged hospital stay is no longer justified, and this is where the idea and importance of Fast Track Surgery has emerged.
"Fast Track Surgery" primarily deals with patient pain and length of hospital stay through various techniques, aiming to reduce postoperative dysfunction, improve recovery, and reduce complications.
Three Stages of Fast Track Surgery:
This technique includes three stages: the preoperative stage, the intraoperative stage, and the postoperative/recovery stage. These stages are equally important and work coordinately to accelerate surgical recovery.
Preoperative Stage of Fast Track Surgery:
• You don't need to fast for a long time before the surgery, but you should refrain from eating for only 6 hours. Dr. Ahmed Abd El Salam limits the duration of abstaining from clear fluids to two hours.
• In the past, it was customary to fast for long periods, up to 12 hours, which led to body fatigue and dehydration.
• Hospital admission occurs on the day of surgery, and the person does not need to stay overnight before the procedure.
• Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant in Bariatric Surgery at Kasr El-Ainy Faculty of Medicine, also focuses in this stage on controlling the medical conditions associated with obesity, such as heart disease and diabetes. He also recommends quitting smoking at least 4 weeks before the surgery to reduce risks and wound healing problems.
• Dr. Ahmed Abd El Salam also educates the patient by providing detailed information and clear explanations about the expected postoperative course, pain medication, dietary program, and the expected discharge time from the hospital. This information reduces the patient's anxiety and need for pain medication, as well as motivates him to adhere to the plan, thereby accelerating the healing process and shortening his hospital stay.
During the Fast Track Surgery:
• Only specific and rare situations, such as patients taking blood thinners or those prone to bleeding, can use drains. Dr. Ahmed Abd El Salam restricts the use of drains to these groups to avoid their drawbacks and problems, such as obstruction and infection, which could cause more harm than benefit. Not using drains allows the patient to move quickly and without pain.
• A urinary catheter is not inserted nor needed, as patients start moving just 2 hours after the procedure.
• Minimally invasive surgical techniques, such as laparoscopy, eliminate the need for large surgical incisions, resulting in fewer complications, less post-surgical pain, and faster recovery.
Postoperative Stage of Fast Track Surgery:
The postoperative phase starts in the recovery room and continues until the patient returns to his normal level of functioning. During this period, the following steps are followed:
• On the day of surgery, a multimodal analgesia (MMA) approach keeps pain levels under control. This involves using a combination of analgesics, NSAIDs, paracetamol, and intravenous anesthetics to achieve the desired pain relief with fewer side effects associated with higher doses of a single medication; this also ensures faster recovery from anesthesia, improving patient recovery and leading to earlier mobilization and discharge.
• As soon as the anesthetic effects wear off, the medical team encourages patients to walk several times and get out of bed at least once every hour.
• Fluids are started within 2 hours after surgery, rather than waiting for gas passage or 24 hours, as previously done.
• The patient resumes solid food intake after 1 week, eliminating the need to wait 2 weeks for stomach healing, which could lead to muscle breakdown. Protein intake also starts after 10 days, such as eggs, fish, and liver, ensuring healthy weight loss by preserving muscle mass.
Bariatric surgeries using the Fast Track technique are gaining widespread acceptance because they are associated with the following:
• Faster recovery compared to traditional care for obese patients.
• Better surgical outcomes.
• Reduced complication rates.
• Shorter hospital stays (from hospital admission to meeting pre-defined discharge criteria).
• Ease of preparation for surgery, fasting for 2 hours for clear fluids and 6 hours for solid foods before surgery.
• Early mobilization and return to oral feeding.
• Reduced number of days off work.
It is known that the surgeon's experience and skill are the most important factors for patient safety and good results. As a result, you will lose your excess weight with a rapid recovery and without catheters or drains, with Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant in Bariatric Surgery at Kasr El-Ainy Faculty of Medicine, who is committed to applying the Fast Track Surgery technique to his patients for the first time in the Middle East.
