Impact of Gastropexy/Omentopexy on Gastrointestinal Symptoms after Laparoscopic Sleeve Gastrectomy

Abstract

Background Laparoscopic sleeve gastrectomy (LSG) has become a single-step operation for the management of severe obesity. A statistically significant number of participants who undergo this procedure experience nausea, vomiting, and reflux symptoms early after the operation. The objectives of this study were to measure the positive or negative effect of gastropexy on reducing distressing postoperative LSG-related gastrointestinal symptoms. Patients and Methods This was a comparative randomized study conducted from January 2018 to January 2021. The study was carried out in the general surgery department at Menoufia University Hospital, Menoufia Faculty of Medicine in Egypt. Two hundred participants were included randomly during this trial. The participants were divided into two groups, with 100 patients in each group. Patients in group A underwent gastropexy, and patients in group B underwent LSG without gastropexy. Results There was no significant difference between the groups in age or sex (p > 0.05). There was no significant difference in the length of hospital stay (p > 0.05). There was a significant difference between the two groups regarding nausea, vomiting, reflux symptoms, and the amount and frequency of antiemetics used (p < 0.001). There was also a significant difference in hospital readmissions (p < 0.05) and in clinic visits during the postoperative period. Conclusions Patients who underwent gastropexy showed a significant reduction in antiemetic consumption and a significantly lower incidence of postoperative nausea, vomiting, gastroesophageal reflux disease symptoms and gastric torsion than those who did not undergo gastropexy. Graphical abstract

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

“…After that, one reference and two guidelines were removed by reading the full text. Finally, 13 studies were included in our final analysis by conducting qualitative synthesis on retained articles 9,10,15–25 . The integrated selecting procedure is shown in the flowchart (Figure 1).…”

“…Finally, 13 studies were included in our final analysis by conducting qualitative synthesis on retained articles. 9,10,[15][16][17][18][19][20][21][22][23][24][25] The integrated selecting procedure is shown in the flowchart (Figure 1).…”

Long-term impact of gastropexy on use of acid-reducing medication, second operations for gastroesophageal reflux and subjective reflux symptoms after sleeve gastrectomy

“…Our study was motivated by the limited data to support routine use of G as an adjunct to SG in patients undergoing surgery for severe obesity. Two smaller randomized trials were previously published, both with one year follow-up, but with con icting conclusions (20,21). In a non-blinded study of 200 patients from Egypt, addressing nausea, vomiting and re ux symptoms during 3 months after surgery, a signi cantly lower proportion of patients after G reported re ux symptoms in the post-operative phase (6% versus 18%), but neither the time of assessment nor the method for capturing patients' symptoms were stated.…”

“…In a non-blinded study of 200 patients from Egypt, addressing nausea, vomiting and re ux symptoms during 3 months after surgery, a signi cantly lower proportion of patients after G reported re ux symptoms in the post-operative phase (6% versus 18%), but neither the time of assessment nor the method for capturing patients' symptoms were stated. In a retrospectively added analysis, patients were interviewed about their ARM use in the post-operative phase, and 8% of patients after G reported to use proton pump inhibitors beyond three months as compared to 23% of those operated with SG only (20). In a smaller randomized study with 60 patients from the United States, both the patient and the interviewer remained unaware of the surgical procedure up until 1 year of follow-up.…”

“…G was pioneered by Lucius D Hill as a surgical treatment for hiatal hernia, but the e cacy of several modi ed techniques of gastric xation to abdominal structures in alleviating GERD after SG is still unclear (18,19). An RCT from Egypt with 200 patients undergoing SG showed a lower incidence of re ux symptoms during the rst three postoperative months after the addition of G, as measured by dose and duration of ARM usage (20).…”