The impact of routine omentopexy to staple line on the incidence of early postoperative complications after laparoscopic sleeve gastrectomy: is it worth?

Abstract

Background In laparoscopic sleeve gastrectomy (LSG), the patients may experience serious postoperative complications such as hemorrhage or leakage. The aim of this study was to evaluate the benefit of routine omentopexy (RO) to staple line in decreasing postoperative hemorrhage and leakage. Patients and methods A retrospective cohort study analyzing prospectively collected data including 2000 LSG from March 2015 to December 2017. The patients were evenly divided into two groups: Group A of 1000 LSG with no omentopexy (NO) and group B of 1000 LSG with RO to staple line with full thickness stitches till the level of the incisura above. Results The mean age was 33.2±15.7 and 30±10.9 for group A (NO) and group B (RO), respectively. The mean BMI in group A is 45±7, while it is 46±9 in group B. Staple line leakage occurred in 9 cases (0.9%) of group A, while none (0.0%) of the group B patients experienced evidence of leakage (P=0.003). In group A, 26 cases were diagnosed to have significant postoperative bleeding, compared with only eight (0.8%) patients of group B (P=0.003). Perigastric localized collection was found in three (0.3%) cases and only one case in the two groups (P=0.625). The operative time spent in group A was 55±20 min, much lower than that in group B which was 85±35 (P=0.001). The mean hospital stay was 30±18 and 24±12 in group A and Group B, respectively (P=0.001). Conclusion RO to staple line has shown to be effective in decreasing staple line bleeding and leakage and hospital stay, although it prolongs the operative time.