288 Role of Aprepitant in Preventing Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Abstract Aim Is to investigate the role of Aprepitant in prevention of postoperative nausea and vomiting post LSG. Method A systematic online search was conducted using electronic databases. Comparative studies of Aprepitant (AP) versus No-Aprepitant (NAP) for preventing nausea and vomiting post-LSG were included. The primary outcome was vomiting in the first two hours and 24 hours post-LSG. The requirement of rescue anti-emetics during the first two and 24 hours were the evaluated secondary outcome parameters. The meta-analysis was performed using Rev Man version 5.3. Results Three studies with a total number of 812 patients were eligible to be included in this review; 408 patients received AP, and 404 patients were allocated to the NAP group. The AP group showed a significantly lower risk for postoperative vomiting at 2 and 24 hours [3% in the AP group vs 7% in the NAP group, Risk ratio (RR) 0.44, P-value = 0.04] and [4.7% in the AP group vs 14.4% in the NAP group (RR 0.33, P-value = 0.0001), respectively. Regarding rescue antiemetics, the NAP group showed a higher requirement for rescue antiemetics compared to the AP group at two hours [27.8% in the AP group vs 41.6% in the NAP group, RR 0.54, P-value = 0.002] and at 24 hours [4.7% in the AP group vs 14.9% in the NAP group, RR 0.20, P-value = 0.0001]. Conclusions Aprepitant provides excellent control of nausea and vomiting post-LSG. It decreases vomiting episodes and the requirement for further doses of anti-emetics, leading to better patient outcomes and satisfaction.