SLEEVE GASTRECTOMY WITH VERSUS WITHOUT OMENTOPEXY. A META-ANALYSIS.
Abdul-Rahman F. Diab*, Sarah Alfieri, Salvatore Docimo, Joseph Sujka, Christopher DuCoin
Department of Surgery, USF Health Morsani College of Medicine, Tampa, FL
Introduction: Although sleeve gastrectomy (SG) is relatively a safe surgical option, various possible complications have been reported in the literature. The most feared complications are staple line leak, hemorrhage, and stenosis. Proposed strategies to reduce some of these complications range from starting the resection at least 3 cm distance from the pylorus, using larger bougie sizes, choosing correct staple height, applying staple line reinforcements, and doing omentopexy (OP). However, there is no ideal method or technique to avoid these complications. The aim of this study was to evaluate outcomes of doing sleeve gastrectomy alone (SG group) versus sleeve gastrectomy with omentopexy (SGOP group).
Methods: Literature search was done according to the PRISMA guidelines. 11 observational cohort studies were included in the analysis. Meta-analysis was done using the RevMen 5.4.1 software. Statistical method used was Mantel-Haenszel. Analysis model used was random effects regardless of the heterogeneity (I2).
Results: There was significantly higher incidence of leaks (OR 4.24, CI 1.78, 10.10) and postoperative bleeding (OR 2.85, CI 1.83, 4.44) in the SG group compared to SGOP group. There was no significant difference between SG to SGOP groups in the incidence of readmission (OR 1.62, CI 0.66, 3.97), gastric twist (OR 0.71, CI 0.03, 14.38), denovo GERD (OR 3.14, CI 0.27, 36.92) and esophagitis (OR 3.47, CI 0.45, 26.48). Length of stay was significantly longer in the SG group compared to the SGOP group (mean difference 0.73, CI 0.30, 1.16). Operative time was significantly shorter in the SG group compared to the SGOP group (mean difference -19.24, CI -25.74, -12.75).
Conclusion: SGOP group had lower incidence of postoperative leaks and postoperative bleeding, and shorter length of stay compared with the SG group. However, SGOP group had a mean increase in operative time of about 20 minutes. Studies comparing omentopexy versus other staple line reinforcement techniques are warranted, as other techniques might be equally effective with less operative time.
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