Impact of Omentopexy on Outcomes of Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The routine use of omentopexy to cover the staple line during laparoscopic sleeve gastrectomy (LSG) remains a topic of debate. We aimed to evaluate comparative outcomes of LSG in patients with or without omentopexy. A systematic search of electronic data sources and bibliographic reference lists was conducted. All randomized controlled trials (RCTs) reporting comparative outcomes of LSG in patients with versus without omentopexy were included, and their risk of bias was assessed. Leakage, bleeding, reintervention, gastric torsion, readmission, nausea, vomiting, reflux, operative time, and length of hospital stay were the evaluated outcome parameters. A total of 10 RCTs were included, reporting a total of 1200 patients with (n = 615) and without (n = 585) omentopexy who underwent LSG. Omentopexy was associated with a significantly lower rate of bleeding (odds ratio (OR): 0.37, 95% CI 0.15 to 0.90, P = 0.03), readmission (OR: 0.22, 95% CI 0.08 to 0.57, P = 0.002), and postoperative nausea (OR: 0.35, 95% CI 0.13 to 0.98, P = 0.05) when compared to no omentopexy. No significant difference was found in the rates of staple line leakage (OR: 0.43, 95% CI 0.14 to 1.30, P = 0.13) or reintervention (OR: 0.22, 95% CI 0.05 to 1.04, P = 0.06) between the two groups. The meta-analysis of the best available evidence from RCTs indicates that omentopexy is associated with a reduced risk of bleeding, readmission, and nausea following LSG. The impact of omentopexy on long-term outcomes requires further research.