11^th Global Gastroenterologists Meeting

Bariatric and metabolic surgery procedures are choice of treatment with an increasing number worldwide. Fluid management is a topic of debate for many years. Restrictive and liberal fluid protocols are under research of clinical trials. Which fluid regime should be the best for bariatric procedures? A low fluid administration may lead to decreased circulating volume, redistribution of plasma, decreased urine output. On the other hand, fluid overload may cause complications as edema, raised central venous pressure, deformation of glycocalyx. There is intestinal edema can lead to impaired tolerance for enteral nutrition. Randomized 48 American Society of Anesthesiologists (ASA) grade 1–3 patients for cholecystectomy operation have been compared with liberal (40 ml/kg) and restricted (15 ml/kg) fluid regime. It has been reported that those receiving liberal therapy had fewer postoperative complications. For a long time, it has been accepted that liberal perioperative intravenous fluid administration was better. There are now more evidence that restricted regimen would be more suitable for fast track colon surgery. Major abdominal surgery has risks, economic results and postoperative complications. Latest RELIEF trial (restrictive versus liberal fluid therapy in major abdominal surgery) has found out preliminary supportive evidence for restrictive regimen for major abdominal surgery. As a conclusion, the perioperative fluid regimen should be individualized. Fluid regimen plays an important role on hospital length of stay for patients undergoing laparoscopic bariatric surgery.