Surgical Endoscopy

, Volume 29, Issue 1, pp 41–47 | Cite as

A prospective randomized controlled trial assessing the efficacy of omentopexy during laparoscopic sleeve gastrectomy in reducing postoperative gastrointestinal symptoms

  • Cheguevara Afaneh
  • Ricardo Costa
  • Alfons Pomp
  • Gregory Dakin



Patients undergoing sleeve gastrectomy experience a significant amount of postoperative gastrointestinal (GI) symptoms. The purpose of our study was to assess the efficacy of omentopexy during laparoscopic sleeve gastrectomy (LSG) in reducing postoperative food intolerance and GI symptoms.


Morbidly obese patients undergoing LSG were randomly assigned to have LSG with or without omentopexy from May 2012 to June 2013. A total of 60 patients were recruited with 30 patients in each group. Patients and the symptom scorer were blinded as to the assigned surgery. All procedures were performed by one of two surgeons utilizing the same surgical technique. Patients were administered standardized surveys, including the Rhodes Index survey, gastroesophageal reflux disease (GERD) impact survey, and Eating Assessment Tool (EAT) survey at various time points postoperatively to assess nausea, vomiting, retching, frequency of GI symptoms, and level of distress.


There was no significant difference in patient age, percent decrease in BMI at any time point, or length of hospitalization between the two groups (P > 0.05). Furthermore, there was no significant difference in Rhodes Index scores, GERD impact scores, or EAT scores at any time point (P > 0.05). Patients in the LSG with omentopexy group required significantly more ondansetron perioperatively (16.1 ± 12.9 mg vs. 10.3 ± 10.2 mg, respectively; P = 0.04); however, there was no difference in metoclopramide requirement (P = 0.22). Surgical morbidity was not significantly different between the two groups (P > 0.05). Finally, there was no significant difference in number of postoperative clinic visits, office telephone encounters, total postoperative readmissions, or postoperative readmissions associated with GI symptoms (P > 0.05).


Omentopexy did not significantly decrease postoperative food intolerance or GI symptoms in morbidly obese patients undergoing LSG. Other methods of mitigating postoperative intolerance to oral intake and GI symptoms should be investigated.


Gastrointestinal symptoms Laparoscopic sleeve gastrectomy Nausea Omentopexy Vomiting 


  1. 1.
    Marceau P, Hould FS, Simard S, Lebel S, Bourque RA, Potvin M, Biron S (1998) Biliopancreatic diversion with duodenal switch. World J Surg 22:947–954PubMedCrossRefGoogle Scholar
  2. 2.
    Gumbs AA, Gagner M, Dakin G, Pomp A (2007) Sleeve gastrectomy for morbid obesity. Obes Surg 17:962–969PubMedCrossRefGoogle Scholar
  3. 3.
    Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery (2010) Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 1:1–5Google Scholar
  4. 4.
    Gagner M, Deitel M, Erickson AL, Crosby RD (2013) Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on sleeve gastrectomy. Obes Surg 23:2013–2017PubMedCrossRefGoogle Scholar
  5. 5.
    Keidar A, Appelbaum L, Schweiger C, Elazary R, Baltasar A (2010) Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg 20:140–147PubMedCrossRefGoogle Scholar
  6. 6.
    Carter PR, LeBlanc KA, Hausmann MG, Kleinpeter KP, deBarros SN, Jones SM (2011) Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 7:569–572PubMedCrossRefGoogle Scholar
  7. 7.
    Chiu S, Birch DW, Shi X, Sharma AM, Karmali S (2011) Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis 7:510–515PubMedCrossRefGoogle Scholar
  8. 8.
    Howard DD, Caban AM, Cendan JC, Ben-David K (2011) Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis 7:709–713PubMedCrossRefGoogle Scholar
  9. 9.
    Baumann T, Grueneberger J, Pache G, Kuesters S, Marjanovic G, Kulemann B, Holzner P, Karcz-Socha I, Suesslin D, Hopt UT, Langer M, Karcz WK (2011) Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration. Surg Endosc 25:2323–2329PubMedCrossRefGoogle Scholar
  10. 10.
    Lazoura O, Zacharoulis D, Triantafyllidis G, Fanariotis M, Sioka E, Papamargaritis D, Tzovaras G (2011) Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg 21:295–299PubMedCrossRefGoogle Scholar
  11. 11.
    Del Castillo Dejardin D, Sabench Pereferrer F, Hernandez Gonzalez M, Blanco Blasco S, Cabrera Vilanova A (2013) Gastric volvulus after sleeve gastrectomy for morbid obesity. Surgery 153:431–433PubMedCrossRefGoogle Scholar
  12. 12.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Moy J, Pomp A, Dakin G, Parikh M, Gagner M (2008) Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg 196:e56–e59PubMedCrossRefGoogle Scholar
  14. 14.
    Himpens J, Dapri G, Cadiere GB (2006) A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 16:1450–1456PubMedCrossRefGoogle Scholar
  15. 15.
    Hamoui N, Anthone G, Kaufman H, Crookes PF (2006) Sleeve Gastrectomy in high-risk patients. Obes Surg 16:1445–1449PubMedCrossRefGoogle Scholar
  16. 16.
    Baumann T, Kuesters S, Gruenberger J, Marjanovic G, Simmermann L, Schaefer AO, Hopt UT, Langer M, Karcz WK (2011) Time-resolved MRI after ingestion of liquids reveals motility changes after laparoscopic sleeve gastrectomy—preliminary results. Obes Surg 21:95–101PubMedCrossRefGoogle Scholar
  17. 17.
    Goitein D, Goitein O, Feigin A, Zippel D, Papa M (2009) Sleeve gastrectomy: radiographic patterns after surgery. Surg Endosc 23:1559–1563PubMedCrossRefGoogle Scholar
  18. 18.
    Akkary E, Duffy A, Bell R (2008) Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy. Obes Surg 18:1323–1329PubMedCrossRefGoogle Scholar
  19. 19.
    Klaus A, Weiss H (2008) Is preoperative manometry in restrictive bariatric procedures necessary? Obes Surg 18:1039–1042PubMedCrossRefGoogle Scholar
  20. 20.
    Dhahri A, Verhaeghe P, Hajji H, Fuks D, Badaoui R, Deguines JB, Regimbeau JM (2010) Sleeve gastrectomy: technique and results. J Visc Surg 147:e39–e46PubMedCrossRefGoogle Scholar
  21. 21.
    Abdemur A, Fendrich I, Rosenthal R (2012) Laparoscopic conversion of laparoscopic sleeve gastrectomy to gastric bypass for intractable gastroesophageal reflux disease. Surg Obes Relat Dis 8:654PubMedCrossRefGoogle Scholar
  22. 22.
    Gagner M, Rogula T (2003) Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg 13:649–654PubMedCrossRefGoogle Scholar
  23. 23.
    Wastell C, Ellis H (1971) Volvulus of the stomach. A review with a report of 8 cases. Br J Surg 58:557–562PubMedCrossRefGoogle Scholar
  24. 24.
    Sevcik WE, Steiner IP (1999) Acute gastric volvulus: case report and review of the literature. CJEM 1:200–203PubMedGoogle Scholar
  25. 25.
    Greenbaum DF, Wasser SH, Riley T, Juengert T, Hubler J, Angel K (2011) Duodenal switch with omentopexy and feeding jejunostomy—a safe and effective revisional operation for failed previous weight loss surgery. Surg Obes Relat Dis 7:213–218PubMedCrossRefGoogle Scholar
  26. 26.
    de Godoy EP, Coelho D (2013) Gastric sleeve fixation strategy in laparoscopic vertical sleeve gastrectomy. Arq Bras Cir Dig 26:79–82PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Cheguevara Afaneh
    • 1
  • Ricardo Costa
    • 1
  • Alfons Pomp
    • 1
  • Gregory Dakin
    • 1
  1. 1.Department of SurgeryNew York-Presbyterian Hospital/Weill Cornell Medical CollegeNew YorkUSA

Personalised recommendations