Omentopexy Effect on the Upper Gastrointestinal Symptoms and the Esophagogastroduodenoscopy Findings in Patients Undergoing Sleeve Gastrectomy

Abstract

Background Laparoscopic sleeve gastrectomy (LSG) has gained acceptance worldwide. However, SG has its own complications that need a specialized management. Omentopexy is a technique in which the sleeved part of the stomach is fixed to the greater omentum. Aim of the Study The present work aimed to investigate the potential effect of omentopexy on the upper GIT disturbances in patients with severe obesity and undergoing LSG. Patients and Methods This study included patients who were recruited for LSG in our institution from June 2019 to October 2020. Patients having no upper GIT symptoms, no esophagogastroduodenoscopy (EGD) GERD signs, and no hiatus hernia were eligible for the study. Patients were randomly enrolled into the omentopexy group (underwent LSG with omentopexy) and the non-omentopexy group (underwent LSG only). Patients were followed up 1 month, 3 months, and 1 year after the operation. EGD was performed at the 1-year follow-up. Results Forty-five patients constituted the omentopexy group and forty-six constituted the non-omentopexy group. Omentopexy was associated with significant reduction in the early post LSG upper GIT symptoms, and less EGD evident reflux esophagitis at the 1-year follow-up (statistically non-significant). Conclusion The current work adds a new evidence of the omentopexy benefits in patients undergoing sleeve gastrostomy, with an overall better outcome in regard to the upper GIT upset and GERD compared to LSG alone. Graphical abstract

Omentopexy/Gastropexy (OP/GP) in Sleeve Gastrectomy Appears to Decrease the Incidence of Gastric Twist, Motility Related Complications, Leaks, and Bleeding. A Meta-Analysis of 17 Comparative Studies and a Plea for Routine OP/GP

“…Although a statistically signi cant increase in operative time was observed in this meta-analysis, some authors including us think that this difference will gradually diminish when surgeons become familiar with OP/GP (17). This might explain the high heterogeneity among studies regarding operative time; in other words, we think that this heterogeneity re ects the variable learning curves for the performing surgeons.…”

“…The theories behind the potential bene ts of OP/GP in reducing PONV Some authors think that the loss of gastric xation to its previous natural axis along the greater curvature might be the reason behind early PONV; therefore, OP/GP might help in preventing such symptoms by restoring that axis trough xation of the staple line to the omentum. Abosayed et al 2022 (17) think that the lower incidence of prolonged postoperative PONV in the OP/GP group might be attributed to better gastric compliance.…”

“…In addition, the decrease is consistent among studies (no heterogeneity) which makes the ndings generalizable. According to Abosayed et al 2022 study (17), the reduced bleeding and leakage incidence in the OP/GP group might be due to the omentum characteristics that help to seal the oozing surfaces. In addition, the lessened twisting and kinking associated with OP/GP might reduce the incidence of proximal leak.…”

“…a Quality score of each study is measured according to NOS scale b This study is an abstract and thus quality appraisal can't be done and isn't applicable (NA) OP/GP omentopexy/gastropexy, C control, M male, F female, YO year-old, BMI body mass index, BS bariatric surgery, USA United States of America, NA not applicable, NR not reported.OP/GP technical detailsOP/GP has not been a standardized procedure yet, and its technique varies among different studies(17). For technical details, refer to table 3 and table 4 in the electronic supplementary material available online.…”

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

“…Omentopexy (Ome) is a procedure which uses sutures to fix the sleeve stomach to the free edge of the greater omentum. Some researchers have suggested that Ome and Gas alleviate the adverse reactions after LSG, but the data are still scarce 8 …”