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Volume 6, Issue 4 (2025)
J Clinic Care Skill 2025, 6(4): 211-218 |
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Received: 2025/08/5 | Accepted: 2025/09/30 | Published: 2025/10/16
Received: 2025/08/5 | Accepted: 2025/09/30 | Published: 2025/10/16
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Sadat S, Shirazi F, Zoladl M, Koohpeyma M. Effect of Early and Gradual Ambulation on Postoperative Complications After Sleeve Gastrectomy. J Clinic Care Skill 2025; 6 (4) :211-218
URL: http://jccs.yums.ac.ir/article-1-445-en.html
URL: http://jccs.yums.ac.ir/article-1-445-en.html
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1- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
2- “Community Based Psychiatric Care Research Center” and “Department of Nursing, Faculty of Nursing and Midwifery”, Shiraz University of Medical Sciences, Shiraz, Iran
3- “Social Determinants of Health Research Center” and “Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Yasuj University of Medical Sciences, Yasuj, Iran
2- “Community Based Psychiatric Care Research Center” and “Department of Nursing, Faculty of Nursing and Midwifery”, Shiraz University of Medical Sciences, Shiraz, Iran
3- “Social Determinants of Health Research Center” and “Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Yasuj University of Medical Sciences, Yasuj, Iran
Abstract (593 Views)
Aims: Sleeve gastrectomy is a widely performed bariatric procedure with long-term benefits; however, it is often accompanied by postoperative complications such as pain, nausea, and vomiting. Early mobilization has been shown to improve recovery and reduce complications in other surgeries; yet, evidence regarding the optimal timing and approach to ambulation after sleeve gastrectomy remains limited. This study aimed to compare the effects of early and gradual ambulation on postoperative complications after sleeve gastrectomy.
Instrument & Methods: In this randomized clinical trial, 132 patients undergoing sleeve gastrectomy were allocated to three groups: early ambulation, gradual ambulation, and control. Early ambulation patients began mobilization 4 hours after entering the ward following a structured protocol, gradual ambulation patients started 7 hours post-surgery according to a gradual protocol, and the control group ambulated based on personal willingness. Postoperative pain intensity was measured using a 10-cm Visual Analog Scale, and vomiting frequency was recorded at admission, immediately after mobilization, and at 6, 12, and 24 hours.
Findings: Early ambulation significantly reduced pain intensity (p<0.001) and vomiting frequency (p<0.01) compared to both the gradual ambulation and control groups. Gradual ambulation also decreased pain compared to the control group (p=0.036) but had no significant effect on vomiting.
Conclusion: Early ambulation is more effective than gradual or conventional ambulation in reducing postoperative complications, particularly pain and vomiting, after sleeve gastrectomy.
Instrument & Methods: In this randomized clinical trial, 132 patients undergoing sleeve gastrectomy were allocated to three groups: early ambulation, gradual ambulation, and control. Early ambulation patients began mobilization 4 hours after entering the ward following a structured protocol, gradual ambulation patients started 7 hours post-surgery according to a gradual protocol, and the control group ambulated based on personal willingness. Postoperative pain intensity was measured using a 10-cm Visual Analog Scale, and vomiting frequency was recorded at admission, immediately after mobilization, and at 6, 12, and 24 hours.
Findings: Early ambulation significantly reduced pain intensity (p<0.001) and vomiting frequency (p<0.01) compared to both the gradual ambulation and control groups. Gradual ambulation also decreased pain compared to the control group (p=0.036) but had no significant effect on vomiting.
Conclusion: Early ambulation is more effective than gradual or conventional ambulation in reducing postoperative complications, particularly pain and vomiting, after sleeve gastrectomy.
Keywords:
Ambulation [MeSH], Postoperative Complications [MeSH], Gastrectomy [MeSH], Pain [MeSH], Vomiting [MeSH]
References
1. Cohen PR. Adult acquired buried penis: A hidden problem in obese men. Cureus. 2021;13(2):e13067. [Link] [DOI:10.7759/cureus.13067]
2. Biörserud C. Excess skin after bariatric surgery-patients' perspective and objective measurements [dissertation]. Gothenburg: University of Gothenburg; 2015. [Link]
3. Gulinac M, Miteva DG, Peshevska-Sekulovska M, Novakov IP, Antovic S, Peruhova M, et al. Long-term effectiveness, outcomes and complications of bariatric surgery. World J Clin Cases. 2023;11(19):4504-12. [Link] [DOI:10.12998/wjcc.v11.i19.4504]
4. Sierżantowicz R, Ładny JR, Lewko J. Quality of life after bariatric surgery-a systematic review. Int J Environ Res Public Health. 2022;19(15):9078. [Link] [DOI:10.3390/ijerph19159078]
5. WHO. News-room fact-sheets detail obesity and overweight [Internet]. Geneva: World Health Organization; 2020 [cited 2024 Sep 28]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. [Link]
6. Baker JS, Supriya R, Dutheil F, Gao Y. Obesity: Treatments, conceptualizations, and future directions for a growing problem. Biology. 2022;11(2):160. [Link] [DOI:10.3390/biology11020160]
7. Cheng J, Gao J, Shuai X, Wang G, Tao K. The comprehensive summary of surgical versus non-surgical treatment for obesity: A systematic review and meta-analysis of randomized controlled trials. Oncotarget. 2016;7(26):39216-30. [Link] [DOI:10.18632/oncotarget.9581]
8. Stenberg E, Dos Reis Falcao LF, O'Kane M, Liem R, Pournaras DJ, Salminen P, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 update. World J Surg. 2022;46(4):729-51. [Link] [DOI:10.1007/s00268-021-06394-9]
9. Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, et al. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: Systematic review and meta-analysis. BMJ. 2017;359:j4849. [Link] [DOI:10.1136/bmj.j4849]
10. Alqunai MS, Alrashid FF. Bariatric surgery for the management of type 2 diabetes mellitus-current trends and challenges: A review article. Am J Transl Res. 2022;14(2):1160-71. [Link]
11. Zambrano AK, Paz-Cruz E, Ruiz-Pozo VA, Cadena-Ullauri S, Tamayo-Trujillo R, Guevara-Ramírez P, et al. Microbiota dynamics preceding bariatric surgery as obesity treatment: A comprehensive review. Front Nutr. 2024;11:1393182. [Link] [DOI:10.3389/fnut.2024.1393182]
12. McCarty TR, Jirapinyo P, Thompson CC. Effect of sleeve gastrectomy on ghrelin, GLP-1, PYY, and GIP gut hormones: A systematic review and meta-analysis. Ann Surg. 2020;272(1):72-80. [Link] [DOI:10.1097/SLA.0000000000003614]
13. Sharma G, Nain PS, Sethi P, Ahuja A, Sharma S. Plasma ghrelin levels after laparoscopic sleeve gastrectomy in obese individuals. Indian J Med Res. 2019;149(4):544-7. [Link] [DOI:10.4103/ijmr.IJMR_984_18]
14. Chen G, Zhang GX, Peng BQ, Cheng Z, Du X. Roux-En-Y gastric bypass versus sleeve gastrectomy plus procedures for treatment of morbid obesity: Systematic review and meta-analysis. Obes Surg. 2021;31(7):3303-11. [Link] [DOI:10.1007/s11695-021-05456-0]
15. Koohpyma M, Sadat S, Afrasiabifar A, Zoladl M. Effect of early mobilization on hemodynamic parameters of patients undergoing sleeve gastrectomy; A randomized clinical trial. J Clin Care Skills. 2020;1(2):55-61. [Link] [DOI:10.52547/jccs.1.2.55]
16. Koohpeyma M, Sadat S, Zoladl M, Afrasiabifar A. Effect of gradual mobilization with bed activity on hemodynamic parameters in patients undergoing sleeve gastrectomy. J Clin Care Skills. 2020;1(3):139-46. [Link] [DOI:10.52547/jccs.1.3.139]
17. Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and risks of bariatric surgery in adults: A review. JAMA. 2020;324(9):879-87. [Link] [DOI:10.1001/jama.2020.12567]
18. Carvalho L, Almeida RF, Nora M, Guimarães M. Thromboembolic complications after bariatric surgery: Is the high risk real?. Cureus. 2023;15(1):e33444. [Link] [DOI:10.7759/cureus.33444]
19. Parola V, Neves H, Duque FM, Bernardes RA, Cardoso R, Mendes CA, et al. Rehabilitation programs for bedridden patients with prolonged immobility: A scoping review protocol. Int J Environ Res Public Health. 2021;18(22):12033. [Link] [DOI:10.3390/ijerph182212033]
20. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Endocr Pract. 2013;9(2):337-72. [Link] [DOI:10.4158/EP12437.GL]
21. Gustafsson U, Scott M, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37(2):259-84. [Link] [DOI:10.1007/s00268-012-1772-0]
22. Liebermann M, Awad M, Dejong M, Rivard C, Sinacore J, Brubaker L. Ambulation of hospitalized gynecologic surgical patients: A randomized controlled trial. Obstet Gynecol. 2013;121(3):533-7. [Link] [DOI:10.1097/AOG.0b013e318280d50a]
23. Asadi F, Ebrahim H, Mazloum R, Jangjo A, Sabouri Noghabi M. The effect of early ambulation on nausea in patients undergoing Appendectomy. Evid Based Care J. 2013;3(1):49-58. [Persian] [Link]
24. Chiarotto A, Maxwell LJ, Ostelo RW, Boers M, Tugwell P, Terwee CB. Measurement properties of visual analogue scale, numeric rating scale, and pain severity subscale of the brief pain inventory in patients with low back pain: A systematic review. J Pain. 2019;20(3):245-63. [Link] [DOI:10.1016/j.jpain.2018.07.009]
25. Javanbakht M, Keshtkaran A, Shabaninejad H, Karami H, Zakerinia M, Delavari S. Comparison of blood transfusion plus chelation therapy and bone marrow transplantation in patients with β-thalassemia: Application of SF-36, EQ-5D, and visual analogue scale measures. Int J Health Policy Manag. 2015;4(11):733-40. [Link] [DOI:10.15171/ijhpm.2015.113]
26. Gholami E, Mohammad Hossini S, Moradian F, Manzouri L, Karimi Z. Effect of pilates on pain control and wound healing in second degree burn patients; A randomized clinical trial. J Clin Care Skills. 2023;4(2):71-5. [Link]
27. Lee TG, Kang SB, Kim DW, Hong S, Heo SC, Park KJ. Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: A prospective randomized controlled trial. Dis Colon Rectum. 2011;54(1):21-8. [Link] [DOI:10.1007/DCR.0b013e3181fcdb3e]
28. Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: The feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207. [Link] [DOI:10.2522/ptj.20110400]
29. Alaa Eldin SMA, Elrefaey NMM, Khamis EAR, Abdelhamed HM. The effect of different positions on clinical outcomes of post coronary catheterization patients: Comparative trial. Egypt J Health Care. 2021;12(3):1899-914. [Link] [DOI:10.21608/ejhc.2021.269397]
30. Vosouqian M, Sadri A, Ghsemi M, Dahi M, Dabagh A. The effect of early ambulation on the prevalence of postoperative headache in patients undergoing cesarean section under spinal anesthesia. Res Med. 2012; 36 (2):89-92. [Persian] [Link]
31. Sao CH, Chan-Tiopianco M, Chung KC, Chen YJ, Horng HC, Lee WL, et al. Pain after laparoscopic surgery: Focus on shoulder-tip pain after gynecological laparoscopic surgery. J Chin Med Assoc. 2019;82(11):819-26. [Link] [DOI:10.1097/JCMA.0000000000000190]
32. Berend KR, Lombardi A, Mallory TH. Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients. Surg Technol Int. 2004;13:239-47. [Link]
33. Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: An overview. Best Pract Res Clin Anaesthesiol. 2019;33(3):259-67. [Link] [DOI:10.1016/j.bpa.2019.07.016]
34. Hinkle JL, Cheever KH. Brunner and Suddarth's textbook of medical-surgical nursing. Maharashtra: Wolters Kluwer India Pvt Ltd; 2018. [Link]
35. Major P, Stefura T, Małczak P, Wysocki M, Witowski J, Kulawik J, et al. Postoperative care and functional recovery after laparoscopic sleeve gastrectomy vs. laparoscopic Roux-en-Y gastric bypass among patients under ERAS protocol. Obes Surg. 2018;28(4):1031-9. [Link] [DOI:10.1007/s11695-017-2964-3]
36. Halliday TA, Sundqvist J, Hultin M, Walldén J. Post‐operative nausea and vomiting in bariatric surgery patients: An observational study. Acta Anaesthesiol Scand. 2017;61(5):471-9. [Link] [DOI:10.1111/aas.12884]
37. Deng LX, Lan-Cao, Zhang LN, Dun-Tian, Yang-Sun, Qing-Yang, et al. The effects of abdominal-based early progressive mobilisation on gastric motility in endotracheally intubated intensive care patients: A randomised controlled trial. Intensive Crit Care Nurs. 2022;71:103232. [Link] [DOI:10.1016/j.iccn.2022.103232]
38. Fathi M, Nasrabadi AN, Valiee S. The effects of body position on chemotherapy-induced nausea and vomiting: A single-blind randomized controlled trial. Iran Red Crescent Med J. 2014;16(6):e17778. [Link] [DOI:10.5812/ircmj.17778]
39. Seok Y, Suh EE, Yu SY, Park J, Park H, Lee E. Effectiveness of integrated education to reduce postoperative nausea, vomiting, and dizziness after abdominal surgery under general anesthesia. Int J Environ Res Public Health. 2021;18(11):6124. [Link] [DOI:10.3390/ijerph18116124]