Effect of omentopexy/gastropexy on gastrointestinal symptoms after laparoscopic sleeve gastrectomy: A meta‐analysis of randomized controlled trials and systematic review

Abstract

Introduction The increased prevalence of obesity worldwide and low incidence of postoperative complications make the laparoscopic sleeve gastrectomy (LSG) a clear public choice for obese‐related individuals. Pre‐existing studies reported contentious outcomes regarding the association with gastrointestinal symptoms after adding omentopexy (Ome) or gastropexy (Gas) to LSG. The present meta‐analysis attempted to evaluate the pros and cons of operating Ome/Gas after LSG concerning gastrointestinal symptoms. Methods The data extraction and study quality assessment were independently performed by two individuals. The PubMed, EMBASE, Scopus, and Cochrane Library databases were systematically searched up to October 1, 2022, using the keywords LSG, omentopexy, and gastropexy to identify randomized controlled trial studies. Results Of the original 157 records, 13 studies with 3515 patients were included. LSG with Ome/Gas excels the LSG group in nausea (odds ratio [OR] = 0.57; 95% CI[0.46, 0.70]; P < .00001), reflux (OR = 0.57; 95% CI [0.46, 0.70]; P < .00001), vomiting (OR = 0.41; 95% CI [0.25, 0.67]; P = .0004) on gastrointestinal symptoms and bleeding (OR = 0.36; 95% CI [0.22, 0.59]; P < .0001), leakage (OR = 0.19; 95% CI [0.09, 0.43]; P < .0001), gastric torsion (OR = 0.23; 95% CI [0.07, 0.75]; P = .01) on post‐LSG complications. Further, LSG with Ome/Gas was superior to LSG regarding the result of excess body mass index loss in 1 year after surgery (mean difference = 1.83; 95% CI [0.59, 3.07]; P = .004). However, no significant associations were shown between groups in wound infection and the resulting weight or body mass index 1 year after surgery. Of note, subgroup analysis indicated that gastroesophageal reflux disease can be alleviated by adding Ome/Gas post‐LSG in those who used small bougies from 32 to 36 Fr (OR = 0.24; 95% CI [0.17, 0.34]; P < .00001) in contrast with large bougies over 36 Fr. Conclusion Most results elucidated the impact of adding Ome/Gas after LSG in reducing the incidence of gastrointestinal symptoms. Additionally, more studies should be conducted to find the relations between other indicators in the present analysis due to the poor cases.

Treatments for Staple Line Leakage after Laparoscopic Sleeve Gastrectomy

“…When a passage disturbance is caused by a stenosis or a twisting distal to the leak site, increased intragastric pressure can make it difficult for the leak site to heal. Therefore, suturing the gastric tube to the mesentery or abdominal wall during reoperation is advisable in preventing such complications [15]. Enteral nutrition has also been reported to accelerate leak healing.…”

The Effects of Reinforcement Techniques in Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Protocol for a Web-Based Survey, Systematic Review, and Meta-Analysis

“…Apart from staple line reinforcement, omentopexy is another type of reinforcement technique, which uses sutures to fix the rest of the stomach to the free edge of the greater omentum [21]. The effect of SG with omentopexy on the rate of postsurgery complications was investigated in 3 systematic reviews [22][23][24], which reported inconsistent results. Of the 3 reviews, 2 [22,24] suggested that SG with omentopexy outperforms SG without omentopexy in reducing gastrointestinal adverse reactions (eg, nausea, reflux, and vomiting), while in terms of reducing gastric leakage, they showed the opposite effects.…”

“…The effect of SG with omentopexy on the rate of postsurgery complications was investigated in 3 systematic reviews [22][23][24], which reported inconsistent results. Of the 3 reviews, 2 [22,24] suggested that SG with omentopexy outperforms SG without omentopexy in reducing gastrointestinal adverse reactions (eg, nausea, reflux, and vomiting), while in terms of reducing gastric leakage, they showed the opposite effects. Opposing results were also observed in 2 reviews [23,24] in terms of the length of hospital stay.…”