When a patient is preparing for bariatric surgery, the operation itself is usually what concerns them most. How is it performed? How long does it take? Will it hurt afterwards? When will I be able to get up? When will I be allowed to go home?
Over the years of working in surgery, I have seen how much our understanding of recovery after surgery has changed. Today, a surgeon's task is not simply to perform the procedure technically well. It is equally important to create conditions in which the body can safely return to normal activity as quickly as possible.
This is the basis of the modern ERAS - Enhanced Recovery After Surgery, or enhanced recovery after surgery, approach.
It is not a single treatment method. It is a comprehensive system of perioperative care that begins before surgery and continues after discharge.
What Is ERAS in Simple Terms?
ERAS is an approach in which we try to avoid creating unnecessary surgical and medication-related stress for the body while also not delaying the natural recovery process.
In bariatric surgery, this approach includes several components:
- proper preparation of the patient before surgery;
- avoiding unnecessarily prolonged fasting;
- modern pain management with reduced reliance on opioid medications;
- prevention of nausea and vomiting;
- rational fluid management;
- early mobilization;
- early reintroduction of oral fluids;
- prevention of thromboembolic complications;
- clear criteria for determining when a patient is ready for discharge.
The ERAS Society has incorporated these principles into specialized recommendations for the perioperative care of patients undergoing bariatric surgery. The updated recommendations take into account data from clinical studies and meta-analyses.
For me, one point is particularly important: enhanced recovery does not mean discharging a patient as quickly as possible at any cost.
Safety always comes first.
The First Hours After Surgery
After laparoscopic bariatric surgery, the patient remains under the supervision of the medical team. During this period, we assess their general condition, pain level, breathing, hemodynamic status, ability to drink, presence of nausea, and other important indicators.
One of the principles of the modern approach is not to keep a person inactive for longer than is actually necessary.
If the patient's condition allows, they gradually begin to mobilize.
This may mean first sitting up, then standing with assistance from medical staff and taking a few steps.
At first glance, a few steps after surgery may seem insignificant. In reality, early mobilization is an important part of postoperative recovery.
It helps patients return to normal activity sooner and is one of the components of preventing postoperative complications.
Why Do We Try to Use Less Strong Pain Medication Today?
Pain after surgery should be controlled. However, modern surgery is gradually moving away from situations in which large doses of opioid medications form the basis of pain management.
ERAS uses multimodal analgesia - a combination of different methods and medications that target different mechanisms of pain.
The goal is simple: to provide the patient with adequate comfort while using the minimum necessary medication burden.
This is particularly important for bariatric patients because after surgery we need to consider not only pain, but also breathing, nausea, drowsiness, and the ability to move normally.
Modern ERAS recommendations specifically emphasize opioid-sparing pain management and prevention of postoperative nausea and vomiting.
Drinking After Bariatric Surgery
One of the questions I hear from practically every patient is:
“When will I be able to drink after surgery?”
The specific protocol depends on the type of surgery, the patient's condition, and the protocol of the particular medical facility.
But the overall approach has changed.
The modern ERAS approach does not automatically require prolonged restriction of fluids simply because the patient has undergone surgery on the stomach.
Once the surgical team has confirmed that the patient's condition is stable and there are no contraindications, oral fluid intake is gradually resumed.
For a patient after bariatric surgery, this is particularly important because dehydration is one of the problems that needs to be prevented from the very first days.
Do You Need to Stay in the Hospital for a Long Time After Surgery?
Not necessarily.
The length of hospitalization is determined not by a desire to “discharge the patient faster,” but by their clinical condition.
Modern protocols use predefined criteria to determine whether a patient is ready for discharge.
The patient should be stable, have their pain under control, tolerate the required amount of fluid, be able to move independently, and have no signs of complications requiring continued observation in the hospital.
A recent systematic review and meta-analysis published in September 2026 in Surgery for Obesity and Related Diseases showed that the use of ERAS protocols in bariatric surgery is associated with a reduction in hospital stay of approximately one day without worsening key safety outcomes. The authors also found reductions in direct medical costs and in some postoperative complications.
Therefore, a shorter hospital stay is not the goal in itself. It is a result of starting many stages of recovery earlier and organizing them more systematically.
Can You Go Home on the Day of Surgery?
In some cases, yes.
In 2026, IFSO published a separate position statement on same-day discharge, meaning discharge on the day of metabolic or bariatric surgery in carefully selected patients.
The analysis included 17 studies involving 46,578 patients. In randomized studies, no statistically significant differences were found between same-day discharge and standard hospitalization in terms of complications, readmissions, or 30-day mortality.
But I want to make an important clarification here.
This does not mean that every patient should be sent home within a few hours after bariatric surgery.
The possibility of early or same-day discharge depends on the individual patient, the type of surgery, underlying medical conditions, postoperative observation findings, the organization of medical care, and the ability to obtain prompt medical assistance if a problem occurs.
I always assess the safety of the individual patient rather than simply following a protocol for the sake of following it.
What Happens After Discharge?
ERAS does not end at discharge.
On the contrary, an important part of recovery begins at this point, with the patient taking an active role.
After bariatric surgery, it is important to:
Drink enough fluids.
The amount and schedule are determined individually according to the recommendations following the specific operation.
Gradually return to physical activity.
Walking and normal daily activities are gradually increased as recovery progresses.
Follow dietary recommendations.
The postoperative diet is advanced gradually. Patients should not independently accelerate the transition between dietary stages simply because they feel well.
Take prescribed medications and vitamin and mineral supplements.
After bariatric surgery, nutrition and prevention of deficiencies become part of long-term medical follow-up.
Do not skip follow-up appointments.
Bariatric surgery is not only about the operation itself. It also involves medical follow-up of changes in weight, metabolism, nutrition, and the patient's overall health.
What I Consider Especially Important to Explain to Patients
I do not think it is right to tell someone, “You will recover quickly after surgery - in a few days you will forget that you even had an operation.”
Every patient's recovery is different.
Some patients begin walking actively very quickly and feel confident after a short period of time. In others, weakness, nausea, or discomfort may persist for longer.
This does not necessarily mean that a complication has occurred.
However, there are symptoms that should not be ignored.
After discharge, patients should contact their doctor if they experience severe or worsening pain, repeated vomiting, an inability to drink, high fever, significant weakness, shortness of breath, chest pain, unusual bleeding, or any other symptoms that cause concern.
After bariatric surgery, it is better to ask your doctor one question too many than to wait on your own, hoping that troubling symptoms will simply go away.
ERAS Is Not About “Discharging Patients Faster”
For me, the modern approach to recovery can be summarized very simply:
fewer unnecessary restrictions - more monitoring; less unnecessary medication burden - more rational pain management; less forced inactivity - earlier mobilization; less formalism around discharge - more attention to the individual patient's readiness.
This is where I see the main advantage of ERAS.
We are not trying to force the body to recover faster.
We are trying to avoid interfering with the body's natural recovery while simultaneously controlling the risks.
Current research confirms that systematic implementation of ERAS in bariatric surgery can shorten hospital stays and improve the organization of postoperative care without increasing the incidence of major complications.
My Main Recommendation to Patients
Do not compare your recovery with someone else's.
After bariatric surgery, what matters is not how quickly you got out of bed or left the clinic.
What matters is that your recovery takes place safely, progressively, and under the supervision of your surgical team.
That is why modern bariatric surgery is no longer just about the operation itself. It is the entire patient journey: preparation, surgery, pain management, early mobilization, nutrition, monitoring, and long-term follow-up.
Emir-Useinov Tair Seitkhalilovich
Surgeon and bariatric surgeon at the Bariatric Surgery Center based at Kyiv City Clinical Hospital No. 1. Specialization: bariatric and laparoscopic surgery.
