Background

Postoperative nausea and vomiting (PONV) is common following bariatric surgery, contributing to increased healthcare utilization and length of stay (LOS). Studies have suggested the benefit of protein-predominant meals in suppressing gastric tachyarrhythmia and PONV. This study investigated the impact of a high-protein postoperative liquid diet on PONV and LOS after primary sleeve gastrectomy (SG).

Methods

This prospective randomized trial included adult patients undergoing primary SG. Exclusion criteria were history of bariatric/foregut surgery, chronic nausea/vomiting, HbA1C >=9, or therapeutic anticoagulation. Patients were randomized 1:1 to receive a bariatric clear liquid (control) or high-protein full-liquid (intervention) diet starting 4 hours postoperatively. The primary endpoint was incidence of PONV. Secondary endpoint was increased LOS due to PONV. Pearson's chi squared test for independence was performed to compare outcomes between both groups on an intention-to-treat basis.

Results

112 patients were randomized (56 control, 56 intervention). Most patients were female (80.4%). All underwent laparoscopic (72.3%) or robotic (27.7%) SG, and 90.2% received inhalational anesthesia. In the intervention arm, 15 patients had zero protein intake due to PONV, 6 had missing data, and 35 had a mean intake of 24.2 grams. There was no observed treatment effect on PONV (78.6% control vs. 89.3% intervention; 95% CI, -0.05% to 0.26%; p=0.20). Almost 70% of patients were discharged home on POD1. Delay in discharge due to PONV was not significant between groups (32.1% control vs. 28.6% intervention; 95% CI, -0.22% to 0.15%; p=0.84).

Conclusions

Early introduction of liquid protein after SG does not improve PONV or LOS.