The perioperative management of the patients in this arm will be according to a fast-track protocol designed by the investigators. The preoperative component of this program is the same as routine practice. Intraoperative and postoperative components which are different to routine practice are as described in the intervention section. This protocol is based on current literature regarding Enhanced Recovery After Surgery (ERAS).

The perioperative management of patients in this arm will be according to routine practice currently implemented at our institution.

Intraoperative:

1. Pre-op carbohydrate loading
2. No pre-op GIK while NBM
3. Pre-medication
4. Dexamethasone 4mg as antiemetic, IV Paracetamol (first dose) Parecoxib 40mg
5. Ondansetron regularly for first 48 hours and Cyclizine, Droperidol or Scopaderm as rescue antiemetics
6. Fluid restriction
7. Standardised method of anaesthesia
8. Give 40ml 0.5% bupivacaine with adrenaline administered prior to placement of laparoscopic port sites
9. 10ml 0.75% ropivacaine diluted to 50ml with 0.9% normal saline solution administered to surgical site prior to procedure

Postoperative:

1. Rescue PCA for up to 12 hours. Oxynorm 5mg for rescue pain. Oxycontin 20mg bd/prn postoperatively
2. Maintenance IV fluids (60ml/hr plasmalyte to be stopped 0800 day 1 post op). Clear oral fluids 2 hours post op. Bariatric free oral fluids morning of day 1
3. Post operative oxygenation
4. Incentive spirometry
5. Drains (e.g. IDC) removed in recovery
6. Full mobilisation 4-8 hours post op)
7. Early Follow up

The trial intends to investigate whether median length of hospital stay for patients under a standardised optimised perioperative care program is less than patients who have routine perioperative care that undergo the same operation.

The study will investigate complication rate for each group identifying incidence, type and severity of complication according to the Clavien Dindo Classification system