Postoperative Nausea and Vomiting After Metabolic Bariatric Surgery: a Comprehensive Review

Metabolic bariatric surgery (MBS) has become an increasingly common treatment for morbid obesity and its comorbidities. Despite significant advances in surgical techniques and anesthesiological management, postoperative nausea and vomiting (PONV) remain frequent complications that significantly affect patient recovery. This review examines the epidemiology, pathophysiological mechanisms, risk factors, clinical features, prevention strategies, and treatment approaches for PONV in patients undergoing metabolic bariatric surgery.

A systematic search was conducted in Cochrane Library, PubMed, and MEDLINE databases for relevant literature published between 2000 and 2024. Keywords included "metabolic bariatric surgery," "postoperative nausea and vomiting," "PONV," "laparoscopic gastric bypass," "sleeve gastrectomy," "PONV prevention," and "PONV treatment." Randomized controlled trials, prospective and retrospective cohort studies, systematic reviews, and meta-analyses were included.

The incidence of PONV after metabolic bariatric procedures ranges from 20% to 70%, depending on the type of surgical intervention, anesthesia techniques, and patient characteristics. PONV after MBS is multifactorial, involving neurohormonal, inflammatory, mechanical, and pharmacological mechanisms. Female gender, non-smoking status, history of PONV or motion sickness, and postoperative opioid use are established risk factors. Multimodal prophylaxis based on individual risk assessment, including 5-HT3 antagonists, NK-1 antagonists, dexamethasone, and non-pharmacological approaches, has shown efficacy. The integration of PONV management into Enhanced Recovery After Surgery protocols has reduced PONV incidence and shortened hospital stays.

Effective PONV management in metabolic bariatric patients requires a multimodal approach to prevention and treatment based on individual risk assessment and application of current pharmacological and non-pharmacological methods. Further research is needed to develop MBS-specific guidelines that consider the unique characteristics of these patients and contemporary surgical techniques.