Evidence-Based Perioperative Prevention of Postoperative Nausea and Vomiting (PONV) in Patients Undergoing...

Background and Objective: Postoperative nausea and vomiting (PONV) ranks among the most common postoperative complications, affecting up to 80% of patients undergoing laparoscopic bariatric surgery. This condition negatively impacts patient comfort and well-being while also potentially delaying ambulation and increasing the risk of anastomotic and wound dehiscence. Although various interventions can mitigate the risk of PONV, none are entirely effective; therefore, combined prophylactic strategies are the standard approach. In recent years, numerous techniques and interventions have emerged; consequently, this scoping review aims to assess the current evidence regarding PONV prevention in patients undergoing laparoscopic bariatric procedures. Methods: This review was conducted in accordance with PRISMA guidelines and registered with OSF. A search was performed across the MEDLINE (PubMed), Scopus, Embase, and Web of Science databases. Inclusion criteria encompassed randomized controlled trials (RCTs) published up to May 2025, focusing on adult patients undergoing laparoscopic bariatric surgeries with PONV as a primary or secondary outcome. Results: A total of 81 studies were included in this review, encompassing a broad range of perioperative techniques, including opioid-sparing adjuvants, regional anesthesia, and pharmacological interventions. Conclusions: While there is general consensus and guidance advocating for a multimodal approach to PONV prevention, debates persist regarding the optimal techniques and antiemetic drug regimens to implement. Emerging evidence, particularly concerning regional anesthesia strategies and combined pharmacological prophylaxis, including novel agents, highlights the potential advantages of innovative approaches. Highlights: Effective management of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery is essential, given its impact on patient comfort, recovery, and the potential to prevent wound or anastomotic dehiscence. Although multimodal antiemetic strategies are regarded as standard, disagreements remain regarding specific measures to be adopted. New techniques and strategies, including advanced regional anesthesia techniques, pharmacological, and non-pharmacological methods, offer promising avenues for improved prophylaxis.