Omentoplasty to Prevent Anastomotic Leak in Colorectal Anastomosis: A Systematic Review and Meta-Analysis

Anastomotic leakage (AL) increases morbidity and mortality in colonic and rectal surgery. Omentoplasty (OMP), the use of a pedicled flap from the omentum to shield the anastomotic site, has been proposed as a potential method to prevent this complication. This study aims to evaluate the effectiveness of OMP in reducing the incidence of AL and its clinical repercussions. We searched PubMed, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) and observational studies comparing OMP and non-omentoplasty (n-OMP) in colonic and rectal surgeries. Mean differences (MDs) were computed for continuous outcomes and odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analysis was performed using R software, version 4.3.3 (R Foundation for Statistical Computing, Vienna, Austria). Eight studies (four RCTs and four observational studies) involving a total of 5,330 patients were included, with 806 patients (15%) in the OMP group and 4,524 patients (85%) in the n-OMP group. Clinical AL, reported in three studies that distinguished leak type, was significantly reduced in the OMP group (OR 0.35; 95% CI 0.15-0.81; p=0.01; I²=0). There were no significant differences in overall AL (OR 0.61; 95% CI 0.33-1.12; p=0.11; I²=56%), radiological AL (OR 0.77; 95% CI 0.40-1.47; p=0.42; I²=0%), reoperation rates (OR 0.63; 95% CI 0.37-1.08; p=0.09; I²=0%), mortality (OR 0.78; 95% CI 0.33-1.86; p=0.58; I²=25%), or postoperative infection rates. OMP was not associated with a significant reduction in overall or radiological AL. Clinical AL, however, was significantly lower in the OMP group, a finding drawn from a small subset of studies that may point to a role for OMP in containing the consequences of a leak rather than preventing it outright. No significant differences were observed in reoperation rates, mortality, or postoperative infection rates. Given the heterogeneity and inclusion of observational data, further RCTs are needed to confirm these findings.