Jumaev Nozim, Teshaev Oktyabr, Rajapov Azamat, Lim Irina
Tashkent Medical Academy, Tashkent, Uzbekistan.
General Military Clinical Hospital of the Uzbekistan, Tashkent, Uzbekistan.
Obes Surg. 2025 Aug;35(8):3206-3220. doi: 10.1007/s11695-025-07998-z. Epub 2025 Jun 18.
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.
代谢性减重手术（MBS）已成为治疗病态肥胖及其合并症越来越常用的方法。尽管手术技术和麻醉管理取得了显著进展，但术后恶心呕吐（PONV）仍然是常见的并发症，严重影响患者康复。本综述探讨了代谢性减重手术患者PONV的流行病学、病理生理机制、危险因素、临床特征、预防策略和治疗方法。
在Cochrane图书馆、PubMed和MEDLINE数据库中系统检索2000年至2024年发表的相关文献。关键词包括“代谢性减重手术”、“术后恶心呕吐”、“PONV”、“腹腔镜胃旁路术”、“袖状胃切除术”、“PONV预防”和“PONV治疗”。纳入随机对照试验、前瞻性和回顾性队列研究、系统评价和荟萃分析。
代谢性减重手术后PONV的发生率在20%至70%之间，具体取决于手术干预类型、麻醉技术和患者特征。MBS后的PONV是多因素的，涉及神经激素、炎症、机械和药理机制。女性、不吸烟、有PONV或晕动病病史以及术后使用阿片类药物是已确定的危险因素。基于个体风险评估的多模式预防措施，包括5-HT3拮抗剂、NK-1拮抗剂、地塞米松和非药物方法，已显示出疗效。将PONV管理纳入术后加速康复方案可降低PONV发生率并缩短住院时间。
代谢性减重手术患者有效的PONV管理需要基于个体风险评估并应用当前药理和非药物方法的多模式预防和治疗方法。需要进一步研究制定考虑这些患者独特特征和当代手术技术的MBS特异性指南。
