Laparoscopic Sleeve Gastrectomy with Omentopexy: Is It Really a Promising Method?—A Systematic Review with Meta-analysis

Abstract

Purpose Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedure worldwide. Omentopexy during LSG is a novel variation of this well-established technique. There are no clear conclusions on indications for this procedure, safeness, and effects of such a method. We aimed to compare the outcomes of laparoscopic sleeve gastrectomy (LSG) with omentopexy (OP) and without omentopexy. Materials and Methods We searched the Medline, EMBASE, and Scopus databases up-to June 2020. Full-text articles and conference abstracts were included for further analysis. This review follows the PRISMA guidelines. Results Of initial 66 records, only 4 studies (N = 1396 patients) were included in the meta-analysis. Our findings showed that LSG with omentopexy had significantly lowered overall morbidity compared to LSG without omentopexy (RR = 0.38; 95% CI [0.15, 0.94]; p=0.04). Gastric leakage rate (RR = 0.17; 95% CI [0.04, 0.76]; p = 0.02) was also significantly lower in LSG with omentopexy. There were no significant differences between groups in length of hospital stay. Conclusions Our meta-analysis showed that LSG with omentopexy may be a feasible procedure for decreasing morbidity and gastric leak rate. However, despite promising results, the procedure needs to be researched more in randomized controlled studies to draw solid conclusions.

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

“…But in the length of hospital stay and postoperative morbidity, we have different ideas. 35 At the same time, the study is aware that our results have several limitations. First of all, the impact of various preoperative preparation, surgical techniques, surgical equipment, and postoperative care cannot be manipulated.…”

“…They found a significant difference between LSG and Ome + LSG groups, indicating that Ome can reduce the incidence of gastric cancer leakage after LSG, which is the same as ours. But in the length of hospital stay and postoperative morbidity, we have different ideas 35 …”

The utility of intraoperative endoscopy to assist novice surgeons in the detection of gastric stenosis during laparoscopic sleeve gastrectomy

“…Leaks remain the most important complication causing significant morbidity and mortality after LSG [ 27 ]. The surgeons made every effort to decrease the incidence of leaks, including omentopexy, staple-line reinforcement, oversewing suture, absorbable polymer membrane, or no reinforcement [ 28 ]. The development of a leak after LSG might result from ischemia in the gastric wall next to the staple line, stenosis of the sleeve, or increased intraluminal pressure related to low compliance of the gastric tube [ 11 , 29 ].…”

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.…”