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

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.