A structured ambulation protocol starting in the PACU significantly accelerates recovery after laparoscopic sleeve gastrectomy.

• Time to first flatus: 18.6 hours in the early ambulation group vs. 24.0 hours in controls (5.4-hour difference, p < 0.001).
• Quality of recovery scores improved in the experimental group on postoperative days 0 (122 vs. 105), 1 (135 vs. 122), and 2 (140 vs. 134), all p < 0.001.

Integrating this protocol into ERAS pathways could enhance patient outcomes without increasing complications.

• No significant difference in adverse events between groups.