The Use of Glucagon-Like Peptide-1 (GLP-1) Agonists in the Perioperative Period: A Case Study

Glucagon-like peptide-1 (GLP-1) receptor agonists, initially developed for type 2 diabetes mellitus (T2DM), have demonstrated efficacy in improving glycemic control and promoting weight loss. However, their use is associated with gastrointestinal side effects, including delayed gastric emptying, which can complicate perioperative care. Current guidelines recommend discontinuing GLP-1 agonists before surgery to reduce risks such as regurgitation and aspiration. Despite these preoperative recommendations, guidance on reintroducing these medications postoperatively is sparse.  This case study discusses a 55-year-old woman with diabetes and uterine fibroids who underwent an elective total laparoscopic hysterectomy with bilateral salpingectomy. Following surgery, the patient resumed a GLP-1 agonist on postoperative day one without specific instructions. Ten days later, she presented with symptoms of nausea, vomiting, and abdominal pain, raising concerns for postoperative ileus or small bowel obstruction (SBO). Imaging revealed delayed transit of enteric contrast, initially interpreted as SBO, leading to a scheduled exploratory laparotomy. However, subsequent radiographic findings and clinical improvement led to the cancellation of surgery, with the patient recovering under conservative management. This case highlights the diagnostic challenges in distinguishing between postoperative ileus, SBO, and GLP-1-induced delayed gastric motility. The overlap in symptoms and imaging findings underscores the importance of cautious clinical assessment to avoid unnecessary surgical interventions. Additionally, it raises critical questions about the appropriate timing, dosing, and monitoring of GLP-1 agonists in the postoperative period. The case emphasizes the need for robust guidelines on postoperative GLP-1 agonist management. With the growing use of these medications, further research is necessary to determine optimal strategies for their reintroduction after surgery, balancing the benefits of metabolic control with the risks of gastrointestinal complications.