Changes in ventilatory mechanics in the postoperative period following bariatric surgery and their clinical implications: An integrative review

Abstract

Introduction: Bariatric surgery is one of the main therapeutic strategies for the treatment of severe obesity and its associated comorbidities. However, the procedure is associated with transient changes in ventilatory mechanics resulting from anesthesia, abdominal surgical manipulation, postoperative pain, and diaphragmatic dysfunction, factors that may impair pulmonary function and increase the risk of respiratory complications. In this context, physiotherapy plays a fundamental role in preventing these complications, promoting respiratory recovery, and restoring functional capacity, requiring integrated action with the medical team and other healthcare professionals. Objective: To address changes in ventilatory mechanics in the postoperative period of bariatric surgery and their clinical impacts, emphasizing the respiratory repercussions resulting from the surgical procedure and the role of physiotherapy within a multidisciplinary approach aimed at preventing complications and optimizing clinical outcomes. Methods: This study consists of a descriptive and analytical literature review conducted through an integrative review methodology. Searches were performed in the Virtual Health Library (VHL), Latin American and Caribbean Health Sciences Literature (LILACS), National Library of Medicine (PubMed), SciVerse Scopus (Scopus), and Scientific Electronic Library Online (SciELO) databases. Sixteen studies published between 2005 and 2020 were included, selected based on their relevance to postoperative ventilatory mechanics alterations following bariatric surgery, encompassing aspects related to pulmonary function, respiratory muscle strength, pulmonary complications, noninvasive ventilation, respiratory physiotherapy, and perioperative rehabilitation strategies. Results: The analyzed evidence indicates that patients undergoing bariatric surgery experience reductions in lung volumes and capacities, impairment of ventilatory mechanics, decreased respiratory muscle strength, and an increased risk of pulmonary complications, particularly during the immediate postoperative period. Frequently observed alterations included reduced vital capacity, limited thoracoabdominal expansion, hypoventilation, and atelectasis. Physiotherapeutic interventions, including respiratory physiotherapy, inspiratory muscle training, noninvasive ventilation, positive airway pressure therapy, and early mobilization, demonstrated positive effects on pulmonary function recovery, prevention of respiratory complications, and improvement of functional capacity. The integration of bariatric surgery, physiotherapy, and multidisciplinary healthcare assistance proved essential for optimizing recovery and improving clinical outcomes. Conclusion: Alterations in ventilatory mechanics constitute an important postoperative consequence of bariatric surgery and may directly influence patients’ clinical recovery. Early and structured physiotherapeutic interventions contribute significantly to preserving respiratory function, restoring functional capacity, preventing pulmonary complications, and optimizing clinical outcomes, establishing physiotherapy as an essential component of perioperative care in this population.