Published online Oct 21, 2026. doi: 10.3748/wjg.120167
Revised: March 30, 2026
Accepted: May 25, 2026
Published online: October 21, 2026
Processing time: 202 Days and 2.3 Hours
Postoperative nausea and vomiting (PONV) remains a common and clinically important problem after laparoscopic sleeve gastrectomy (LSG), even with routine multimodal prophylaxis. Existing studies have often relied on retrospective designs or simple binary outcomes, which may not adequately reflect the full burden of postoperative symptoms.
To estimate the incidence and severity of PONV after LSG and to identify perioperative factors associated with its development.
This prospective cohort study included consecutive adults undergoing elective LSG between March 2022 and December 2023. PONV was assessed using the validated Chinese version of the Index of Nausea, Vomiting, and Retching at seven time points during the first 3 postoperative days. Demographic, clinical, and perioperative data were collected. Potential predictors were screened using least absolute shrinkage and selection operator regression and then entered into multivariable logistic regression models.
A total of 1054 patients were included in the final analysis. During the 3-day postoperative period, 804 patients experienced at least one episode of PONV, yielding an overall incidence of 76.3%. Nausea occurred in 73.7% of patients, vomiting in 50.3%, and retching in 35.0%. In multivariable analysis, intraoperative dexmedetomidine use was independently associated with a lower risk of PONV [odds ratio (OR) = 0.50; 95%CI: 0.36-0.70; P < 0.001]. Apfel scores of 3 (OR = 4.27; 95%CI: 1.33-13.55; P = 0.013) and 4 (OR = 4.93; 95%CI: 1.51-15.94; P = 0.007) were associated with an increased risk.
PONV remains highly prevalent after LSG despite guideline-based prophylaxis. Intraoperative dexmedetomidine was associated with a reduced risk of PONV, whereas higher Apfel scores predicted an increased risk. These findings may help refine antiemetic strategies for patients undergoing LSG.
Core Tip: In this prospective cohort study of 1054 patients undergoing laparoscopic sleeve gastrectomy, postoperative nausea and vomiting (PONV) remained highly prevalent despite multimodal prophylaxis, affecting 76.3% of patients. Using the validated Index of Nausea, Vomiting, and Retching, we found that intraoperative dexmedetomidine was associated with lower odds of PONV, whereas Apfel scores of 3-4 were associated with a substantially increased risk even with guideline-based prevention. These findings suggest a potential benefit of dexmedetomidine in this setting, although randomized controlled trials are needed to confirm causality. More effective antiemetic strategies, including additional pharmacological and non-pharmacological approaches, may be warranted for patients at high risk of PONV after laparoscopic sleeve gastrectomy.