Venous thromboembolism (VTE) is one of the common complications after bariatric/metabolic surgery, and extremely obese patients have a higher risk of VTE occurrence. Here, the authors conducted a review and analysis of relevant guidelines and literature from both domestic and international sources, incorporated with the clinical experience of their center, to organize and summarize perioperative VTE prevention and management protocols for extremely obese patients, with the aim of providing guidance for the prevention and treatment of VTE.