Omentopexy after laparoscopic sleeve gastrectomy in children and adolescents: is it effective in reducing post-operative complications?

Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed restrictive bariatric procedures. Postoperative gastrointestinal complications are distressing in patients who have undergone this procedure. Most of these complications can be prevented by omentopexy as a modification on laparoscopic sleeve gastrectomy. The purpose of this study was to evaluate the effectiveness of omentopexy during laparoscopic sleeve gastrectomy in reducing postoperative complications. This prospective comparative study, conducted between January 2015 and October 2024 at Al-Azhar University Hospitals, encompassed 48 pediatric patients diagnosed with obesity. The patients were randomly allocated into two groups: group 1 comprised 24 patients treated with LSG with omentopexy and group 2 comprised 24 patients treated with LSG without omentopexy. Preoperative data and postoperative outcomes were collected for all patients in each group. 48 morbidly obese patients, divided into two groups of 24 each, were included in this study. Both groups were comparable in baseline characteristics including age, sex distribution, BMI, preoperative GERD-Q scores, and comorbidities. Operative times were significantly longer in the omentopexy group (64.23 ± 8.12 min) compared to the non-omentopexy group (54.15 ± 5.02 min, P = 0.044). The omentopexy group had significantly lower rates of nausea (8.3% vs. 20.8%), vomiting (8.3% vs. 33.3%), and regurgitation (8.3% vs. 16.6%). One case of staple line leak occurred in the non-omentopexy group, a difference that was not statistically significant. Hospital stay was significantly shorter in the omentopexy group (1.78 ± 0.858 days) compared to the non-omentopexy group (4.47 ± 1.25 days, P = 0.011). Both groups achieved comparable weight loss (BMI: 27.35 ± 4.57 vs. 28.85 ± 5.68) and postoperative GERD-Q scores (6.73 ± 1.86 vs. 6.85 ± 2.01), indicating similar efficacy in the treatment of obesity. Omentopexy following laparoscopic sleeve gastrectomy is associated with a significant reduction in early post-operative nausea and vomiting and a shorter hospital stay. While there were no staple line leaks in the omentopexy group, this study was not powered to definitively conclude a reduction in this complication. Also, the extent to which this technique alleviates gastroesophageal reflux disease remains uncertain.