Glucagon-Like Peptide-1 Receptor Agonists in Gynecologic Surgery

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have rapidly expanded beyond their initial role in diabetes management to become prominent agents for weight loss and metabolic optimization. A growing number of patients receiving these therapies are presenting for gynecologic surgery. This narrative review summarizes current evidence on GLP-1 RAs, including their mechanisms of action, clinical benefits, and perioperative considerations, with particular attention to their effects on gastric emptying and the associated risk of aspiration. Early recommendations advised routine discontinuation of GLP-1 RAs before surgery because of theoretical concerns about delayed gastric emptying. However, recent multisociety guidance supports continued use for most patients, with individualized risk assessment and perioperative strategies such as preoperative liquid diets for those at higher risk. These evolving recommendations reflect a shift toward balancing the metabolic and weight loss benefits of GLP-1 RAs with perioperative safety considerations. As clinical experience with these agents grows, ongoing research and multidisciplinary collaboration remain essential to ensure optimal outcomes for patients undergoing gynecologic surgery.