Laparoscopic and robotic surgery, prevention and management of post-operative complications, but also microbiota, nutrition and drugs. These are the focuses scheduled at the 32nd National Congress of the Italian Society of Obesity Surgery (Sicob) entitled ‘Obesity: in search of a new therapeutic alliance’, scheduled from 23 to 25 May at Giardini Naxos (Messina). Around a thousand specialists were present, with a significant presence of under 40s.
The initiative – reports a note – will constitute an essential moment of discussion on the state of bariatric surgery, in particular on the dissemination in all centers of a protocol for the perioperative management of obese patients already adopted in some accredited centers, which allows for rapid recovery post-operative treatment of the patient undergoing surgery through the application of a multimodal path aimed at reducing stress, pain, nausea, vomiting in the absence of tubes, drainage and catheters. “The application of this protocol ensures a better patient experience and short-term hospitalizations, as well as an almost immediate recovery – declares Giuseppe Navarra, president of Sicob – Eras is the acronym that globally identifies this new approach. During the congress we will propose a protocol adapted to the Italian reality which we hope can be shared by Sicob members and then widely adopted throughout the national territory. The company will then take responsibility for verifying the adoption of the protocols at the level of the individual centers which may therefore be accredited”.
“My experience with the fast track management protocols of the perioperative in bariatrics dates back to 2013, and after more than 10 years it continues to bear excellent fruit – reports Giuseppe Maria Marinari, head of the Bariatric Surgery Unit at Irccs Humanitas in Milan – The results leave all very satisfied: reduced complications, therefore full safety, but also increased quality perceived by the patient. The adoption of these protocols makes surgery gentler and puts patients at the centre, returning them to their daily lives quickly and in good conditions. We can talk without fear about the humanization of care. It should be forgotten that even hospital managers are satisfied: these protocols increase the sustainability of surgery, essentially allowing more people to be treated with the same resources in terms of hospital beds.”
To “obtain these results – adds Marinari – it is necessary to work on four fronts: creation of an efficient and effective team (collaboration with anesthetists and nurses is essential), great attention to pre-operative preparation in order to reduce the risk of complications, belief in abandon some traditions transmitted to us by our teachers, follow the patient even after discharge”.
In the pre-operative phase – Sicob points out – counseling is central, a phase in which the patient is instructed on all the stages of his journey, so as to reduce his anxiety and increase his awareness. As regards the intervention, minimally invasive approaches are chosen, through laparoscopic and robotic surgery, therefore without cuts, but only with very light incisions. The role of the anesthesiologist is fundamental and will follow anesthetic protocols that limit the use of opiates to a minimum, reducing the risk of post-operative nausea, pain and vomiting.
“If these measures are adopted – says Navarra – the postoperative phase is less impactful and consequently the patient can leave the hospital earlier. Waking up is almost immediate at the end of the operation, the patient is able to leave the bed, sip liquids and resume a minimum diet after a few hours and can return home within 48 hours rather than after 4-5 days typical of classic management. Except in particular cases, tubes, drains and catheters are no longer used. Discharge still occurs only after a scrupulous visit and the completion of a specific and detailed check list. Reducing hospitalization from 5 to 2 days also means saving resources on the one hand, but above all, beds available for other patients and interventions”.
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