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Omentopexy versus no omentopexy in sleeve gastrectomy: an updated systematic review and meta-analysis

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Abstract

Laparoscopic sleeve gastrectomy with omentopexy (O-LSG) has been compared to laparoscopic sleeve gastrectomy with no-omentopexy (NO-LSG) in terms of postoperative outcomes and one-year anthropometric results. This systematic review with meta-analysis aimed to compare the utility of omentopexy in sleeve gastrectomy. We performed a systematic review with meta-analysis according to PRISMA 2020 and AMSTAR 2 guidelines. We included studies that systematically searched electronic databases and compared the O-LSG with the NO-LSG conducted through 1st March 2023. The bibliographic research yielded 13 eligible studies. These studies included 5514 patients. The O-LSG is associated with lower leakage (OR = 0.22; 95% CI [0.08, 0.55], p = 0.001), bleeding (OR = 0.33; 95% CI [0.19, 0.57], p < 0.0001), vomiting (OR = 0.50; 95% CI [0.28, 0.89], p = 0.02), twist (OR = 0.09; 95% CI [0.02, 0.39], p = 0.001), and shorter hospital stay (MD = − 0.33; 95% CI [− 0.61, − 0.05], p = 0.02) compared with NO-LSG. The O-LSG is associated with longer operative time (MD = 8.15; 95% CI [3.65, 12.64], p = 0.0004) than the NO-LSG. There were no differences between the two groups in terms of postoperative GERD (OR = 0.53; 95% CI [0.27, 1.02], p = 0.06), readmission (OR = 0.60; 95% CI [0.27, 1.37], p = 0.23), and one-year total weight loss (MD = 2.06; 95% CI [− 1.53, 5.65], p = 0.26). In the subgroup analysis including only RCTs, postoperative GERD was lower in the O-LSG (OR = 0.26; 95% CI [0.11, 0.63], p = 0.003). Our systematic review and meta-analysis concluded that omentopexy in sleeve gastrectomy is feasible and safe It reduced leakage, bleeding, and twist. It probably increased the operative time. It may reduce vomiting, GERD, and hospital stay. We don't know if it led to an additional readmission rate or one-year total weight loss.

Registration The protocol was registered in PROSPERO with the ID CRD42022336790.

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References

  1. Welbourn R, Hollyman M, Kinsman R, Dixon J, Liem R, Ottosson J et al (2019) Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018. Obes Surg mars 29(3):782–795

    Article  Google Scholar 

  2. Aurora AR, Khaitan L, Saber AA (2012) Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc juin 26(6):1509–1515

    Article  Google Scholar 

  3. Jossart GH (2010) Complications of sleeve gastrectomy: bleeding and prevention. Surg Laparosc Endosc Percutan Tech juin 20(3):146–147

    Article  Google Scholar 

  4. Bransen J, Gilissen LPL, van Rutte PWJ, Nienhuijs SW (2015) Costs of leaks and bleeding after sleeve gastrectomies. Obes Surg 25(10):1767–1771

    Article  PubMed  Google Scholar 

  5. Oweira H, Mazotta A, Mehrabi A, Reissfelder C, Rahbari N, Betzler A et al (2022) Using a reinforced stapler decreases the incidence of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis. World J Surg 46:1–11

    Article  Google Scholar 

  6. Dziri C, Paquet JC, Hay JM, Fingerhut A, Msika S, Zeitoun G et al (1999) Omentoplasty in the prevention of deep abdominal complications after surgery for hydatid disease of the liver: a multicenter, prospective, randomized trial. French associations for surgical research. J Am Coll Surg 188(3):281–289

    Article  CAS  PubMed  Google Scholar 

  7. Lin BC, Liao CH, Wang SY, Hwang TL (2017) Laparoscopic repair of perforated peptic ulcer: simple closure versus omentopexy. J Surg Res 220:341–345

    Article  PubMed  Google Scholar 

  8. D’Ugo S, Gentileschi P, Benavoli D, Cerci M, Gaspari A, Berta RD et al (2014) Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Related Dis 10(3):450–454

    Article  Google Scholar 

  9. Zarzycki P, Kulawik J, Małczak P, Rubinkiewicz M, Wierdak M, Major P (2021) Laparoscopic sleeve gastrectomy with omentopexy: is it really a promising method?—A systematic review with meta-analysis. Obes Surg 31(6):2709–2716

    Article  PubMed  PubMed Central  Google Scholar 

  10. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 372:n160

    Article  PubMed  PubMed Central  Google Scholar 

  11. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg sept 73(9):712–716

    Article  Google Scholar 

  12. Campbell MK, Elbourne DR, Altman DG (2004) CONSORT statement: extension to cluster randomised trials. BMJ 328(7441):702–708

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:14898

    Google Scholar 

  14. Peterson J, Welch V, Losos M, Tugwell P (2011) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hosp Res Ins 2(1):1–12

    Google Scholar 

  15. Higgins JP (2008) Cochrane handbook for systematic reviews of interventions version 5.0. 1. The Cochrane Collaboration. http://www.cochrane-handbook.org

  16. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1):1–10

    Article  Google Scholar 

  17. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  18. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J et al (2011) GRADE guidelines: 3 rating the quality of evidence. J Clin Epidemiol 64(4):401–406

    Article  PubMed  Google Scholar 

  19. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: Cochrane book series.

  20. Abdallah E, Zakaria M, Fikry M, Abdelnaby M, Gado W, Elbaz SA et al (2020) Laparoscopic sleeve gastrectomy with T-shaped omentoplasty: impact on the early postoperative outcomes. Obes Surg 30(10):3735–3741

    Article  PubMed  Google Scholar 

  21. Abosayed AK, Mostafa MS (2022) Omentopexy effect on the upper gastrointestinal symptoms and the esophagogastroduodenoscopy findings in patients undergoing sleeve gastrectomy. Obes Surg 32(6):1864–1871

    Article  PubMed  PubMed Central  Google Scholar 

  22. Abou-Ashour HS (2022) Impact of gastropexy/omentopexy on gastrointestinal symptoms after laparoscopic sleeve gastrectomy. Obes Surg 32(3):729–736

    Article  PubMed  Google Scholar 

  23. Afaneh C, Costa R, Pomp A, Dakin G (2015) A prospective randomized controlled trial assessing the efficacy of omentopexy during laparoscopic sleeve gastrectomy in reducing postoperative gastrointestinal symptoms. Surg Endosc 29(1):41–47

    Article  PubMed  Google Scholar 

  24. AlHaddad M, AlAtwan AA, AlKhadher T, AlJewaied A, Qadhi I, AlSabah SK (2021) Omentopexy during laparoscopic sleeve gastrectomy: is it effective in reducing postoperative gastrointestinal symptoms. A retrospective cohort study. Ann Med Surg (Lond) 65:102369

    PubMed  Google Scholar 

  25. Fouad MMB, Ibraheim SMN, Ibraheim P, Maurice KK, Saber AT (2022) Assessment of the role of omentopexy in laparoscopic sleeve gastrectomy: a tertiary center experience. J Laparoendosc Adv Surg Tech A 32(9):962–968

    Article  PubMed  Google Scholar 

  26. Khalifa I, Balamoun H, Lasheen O, Ibrahim M, Mashhour A, Kandeel A (2018) Effect of omental reattachment on food tolerance and gastric emptying in laparoscopic sleeve gastrectomy. Bariatr Surg Pract Patient Care 13:68

    Google Scholar 

  27. Lale A, Aygen E, Kirkil C, Artas H, Yur M (2020) Efficacy of staple line reinforcement with omentopexy during laparoscopic sleeve gastrectomy on postoperative complications: experience of a single center. Surg Laparosc Endosc Percutan Tech 31(2):181–187

    Article  PubMed  Google Scholar 

  28. Nosrati SS, Pazouki A, Sabzikarian M, Pakaneh M, Kabir A, Kermansaravi M (2021) Can omentopexy reduce the incidence of gastroesophageal reflux disease after laparoscopic sleeve gastrectomy. Obes Surg 31(1):274–281

    Article  PubMed  Google Scholar 

  29. Pilone V, Tramontano S, Renzulli M, Romano M, Monda A, Albanese A et al (2019) Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study. BMC Surg 19(Suppl 1):56

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sharma N, Chau WY (2020) Remodifying omentopexy technique used with laparoscopic sleeve gastrectomy: does it change any outcomes? Obes Surg avr 30(4):1527–1535

    Article  Google Scholar 

  31. Våge V, Behme J, Jossart G, Andersen JR (2020) Gastropexy predicts lower use of acid-reducing medication after laparoscopic sleeve gastrectomy. A prospective cohort study. Int J Surg 74:113–117

    Article  PubMed  Google Scholar 

  32. Yapalak Y, Yigman S, Gonultas C, Coskun H, Yardimci E (2023) The effects of the staple line reinforcement procedures on gastrointestinal symptoms and its early results in sleeve gastrectomy. J Laparoendosc Adv Surg Tech A 33(2):162–170

    Article  PubMed  Google Scholar 

  33. Chaouch MA, Kellil T, Taieb SK, Zouari K (2021) Barbed versus conventional thread used in laparoscopic gastric bypass: a systematic review and meta-analysis. Langenbecks Arch Surg 406(4):1015–1022

    Article  PubMed  Google Scholar 

  34. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M (2013) Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg févr 257(2):231–237

    Article  Google Scholar 

  35. Shoar S, Poliakin L, Khorgami Z, Rubenstein R, El-Matbouly M, Levin JL et al (2017) Efficacy and safety of the over-the-scope clip (OTSC) system in the management of leak and fistula after laparoscopic sleeve gastrectomy: a systematic review. Obes Surg 27(9):2410–2418

    Article  PubMed  Google Scholar 

  36. Gagner M, Buchwald JN (2014) Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Related Dis 10(4):713–723

    Article  Google Scholar 

  37. Knapps J, Ghanem M, Clements J, Merchant AM (2013) A systematic review of staple-line reinforcement in laparoscopic sleeve gastrectomy. JSLS J Soc Laparoendosc Surg 17(3):390

    Article  Google Scholar 

  38. Dogra P, Kaushik R, Singh S, Bhardwaj S (2023) Risk factors for leak after omentopexy for duodenal ulcer perforations. Eur J Trauma Emerg Surg 49(2):1163–1167

    Article  PubMed  Google Scholar 

  39. Litbarg NO, Gudehithlu KP, Sethupathi P, Arruda JAL, Dunea G, Singh AK (2007) Activated omentum becomes rich in factors that promote healing and tissue regeneration. Cell Tissue Res 328(3):487–497

    Article  CAS  PubMed  Google Scholar 

  40. Deitel M, Gagner M, Erickson AL, Crosby RD (2011) Third international summit: current status of sleeve gastrectomy. Surg Obes Related Dis 7(6):749–759

    Article  Google Scholar 

  41. Halliday TA, Sundqvist J, Hultin M, Walldén J (2017) Post-operative nausea and vomiting in bariatric surgery patients: an observational study. Acta Anaesthesiol Scand mai 61(5):471–479

    Article  CAS  Google Scholar 

  42. Slater BJ, Collings A, Dirks R, Gould JC, Qureshi AP, Juza R et al (2022) Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD). Surg Endosc. https://doi.org/10.1007/s00464-022-09817-3

    Article  PubMed  PubMed Central  Google Scholar 

  43. Filho AMM, Silva LB, Godoy ES, Falcão AM, de Quadros LG, Zotarelli Filho IJ et al (2019) Omentopexy in sleeve gastrectomy reduces early gastroesophageal reflux symptoms. Surg Laparosc Endosc Percutan Techiques. 29(3):155–161

    Article  Google Scholar 

  44. Abd Ellatif ME, Abbas A, El Nakeeb A, Magdy A, Salama AF, Bashah MM et al (2017) Management options for twisted gastric tube after laparoscopic sleeve gastrectomy. Obes Surg 27(9):2404–2409

    Article  PubMed  Google Scholar 

  45. Burgos AM, Csendes A, Braghetto I (2013) Gastric stenosis after laparoscopic sleeve gastrectomy in morbidly obese patients. Obes Surg 23(9):1481–1486

    Article  PubMed  Google Scholar 

  46. Elbalshy MA, Fayed AM, Abdelshahid MA, Alkhateep YM (2017) Role of staple line fixation during laparoscopic sleeve gastrectomy. Int Surg J 5(1):156

    Article  Google Scholar 

  47. Arslan E, Banli O, Sipahi M, Yagci G (2018) Effects and results of omentopexy during laparoscopic sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech 28(3):174–177

    Article  PubMed  Google Scholar 

  48. Kermansaravi M, Parmar C, Chiappetta S, Shikora S, Aminian A, Abbas SI et al (2023) Best practice approach for redo-surgeries after sleeve gastrectomy, an expert’s modified Delphi consensus. Surg Endosc 37(3):1617–1628

    Article  PubMed  Google Scholar 

  49. Labib MF (2020) The omentopexy role in the prevention of post-operative gastric sleeve surgery complications. Egypt J Hosp Med 81(6):2199–2204

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia

    Mohamed Ali Chaouch, Sadok Ben Jabra, Mariem Jouilli, Ramzi Nouira & Faouzi Noomen

  2. Department of Visceral and Digestive Surgery, Charles Nicolle Hospital, Tunis, Tunisia

    Mehdi Khalfallah

  3. Department of Gastroenterology, Monastir University Hospital, Monastir, Tunisia

    Om Kalthoum Sallem

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  1. Mohamed Ali Chaouch
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All authors participated in the study on the conception, design of the research, and data acquisition. All the authors validated the final version of the article.

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Correspondence to Mohamed Ali Chaouch.

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Chaouch, M.A., Khalfallah, M., Jabra, S.B. et al. Omentopexy versus no omentopexy in sleeve gastrectomy: an updated systematic review and meta-analysis. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01794-7

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