Trial reportObesity surgery2026
Ultra-early Physiotherapy Mobilization within ERAS (Enhanced Recovery after Surgery) with Incentive Spirometry after Laparoscopic Sleeve Gastrectomy in Metabolic Bariatric Surgery: Randomized Clinical Trial.
Trial report in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
9 authors.
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Abstract
backgroundUltra-early physiotherapy mobilization within ERAS pathways (≤ 24 h) is a modifiable intervention with potential impact on recovery in patients with severe obesity undergoing laparoscopic sleeve gastrectomy (LSG). Incentive spirometry (IS) may serve as an adjunct; device configuration can influence inspiratory mechanics and early ventilatory recovery.
methodsThis was a prospective, single-center randomized clinical trial conducted at a metabolic bariatric surgery center (October 2019–October 2022). Adults undergoing elective LSG were randomized to flow-oriented IS (Flow-IS; n = 88) or volume-oriented IS (Volume-IS; n = 75). All patients followed a standardized ERAS pathway with physiotherapy-led mobilization initiated within 60 min of extubation. Spirometry was assessed preoperatively (PRE), immediately postoperatively (POi), and on postoperative day 1 (PO1) according to ATS/ERS standards. The primary endpoint was the change in maximal voluntary ventilation (MVV, L/min) from POi to PO1, analyzed using ANCOVA adjusted for baseline MVV and pre-specified covariates. Secondary outcomes included FVC, FEV₁, PEF, oxygenation, hemodynamics, dyspnea, pain, and 90-day respiratory events.
resultsA total of 163 patients were randomized; >95% completed PO1 assessments. Volume-IS yielded significantly greater MVV recovery from POi to PO1 compared with Flow-IS (adjusted difference + 12.6 L/min; 95% CI 9.3–15.9; p < 0.001). Secondary trajectories favored Volume-IS for FVC, FEV₁, and PEF (all p < 0.01), with comparable hemodynamic profiles. No ICU admissions, respiratory complications, or readmissions occurred within 90 days.
conclusionWithin ERAS for LSG, ultra-early physiotherapy mobilization represents a key component of safe recovery. IS is adjunctive; volume-oriented devices provide modest, consistent improvements in early spirometric recovery compared with flow-oriented systems.
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