肥満と減量療法のジャーナル

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Laparoscopic Sleeve Gastrectomy: One Institution's Experience with Omentopexy in the Prevention of Gastric Leaks (Retrospective Review)

Paul Hanna, Ricardo Mohammed, Manvir Nijjar, Franklyn Vazquez, Mark Connolly and Jamshed Zuberi

Background: The omentum is associated with accelerated wound healing properties. This IRB-approved multisurgeon single-center study is aimed to evaluate whether complications are reduced by omentopexy (OP) to the staple line after a laparoscopic sleeve gastrectomy.

Methods: Adults who have undergone a laparoscopic sleeve gastrectomy at St. Joseph’s Regional Medical Center were reviewed. The group which had the OP performed was compared to the group which did not. Controls were matched for concurrent hiatal hernia repair, degree of obesity, and operating surgeon. OP was only performed by a single surgeon (Surgeon A), however several surgeons performed laparoscopic sleeve gastrectomies. Data extracted included demographics, indication, diagnostic investigations, treatments given, perioperative outcomes, findings, response to treatment given and survival. Complications were defined as a definitive leak or abscess seen on CT or upper GI study.

Results: A total of 181 patients underwent a laparoscopic sleeve gastrectomy, of which 75 patients (41%) also underwent OP. 18 patients (9.9%) had a concurrent hiatal hernia repair. Complications were found in 5 patients (2.76%). 4 of the 5 patients who had a complication had underwent OP. Complication rates between the group which had OP and the group which did not have OP showed an OR 6.0571, 95% CI 0.6631 to 55.3280, P 0.1105. No complications were observed in patients who had a concurrent hiatal hernia repair. An association was observed between Surgeon A and increased complications in patients who underwent OP (OR 5.0979, 95% CI 0.2676 to 97.1194, P 0.2787) as well as those who did not undergo OP (OR 1.8271, 95% CI 0.0727 to 45.9307, P 0.7141). An association was also seen between complications and patients who are super obese (OR 1.0833, 95% CI 0.1172 to 10.0126, P 0.9438) and severely obese (OR 2.2319, 95% CI 0.3378 to 14.5153, P 0.3603). No association was seen between complications and patients who are morbidly obese (OR 0.4950, 95% CI 0.0807 to 3.0371, P 0.4474).

Limitations: Small sample size, limited patient population, complication rates of a single surgeon performing the omentopexies, comorbidities, as well as limitations of retrospective analysis.

Conclusion: OP to the staple line is not associated with decreased overall complication rates. Concurrent hiatal hernia repair was not associated with complications. OP performed in patients who are super obese or severely obese had more complications as opposed to morbidly obese patients who had decreased complications. In addition, OP may be associated with decreased complications only in patients who are morbidly obese. In conclusion, one cannot, in good conscience, continue performing omentopexy given the significantly higher complication rate noted.