A Prospective Randomized Controlled Trial Assessing the Efficacy of Omentopexy During Laparoscopic Sleeve Gastrectomy in Reducing Postoperative Gastrointestinal Symptoms

Cheguevara Afaneh, MD, Ricardo Costa, BS, Alfons Pomp, MD, Gregory Dakin, MD. New York-Presbyterian Hospital/Weill Cornell Medical Center.

Objective: Patients undergoing sleeve gastrecomy experience a significant amount of postoperative gastrointestinal symptoms. The purpose of our study was to assess the efficacy of omentopexy during laparoscopic sleeve gastrectomy (LSG) in reducing postoperative gastrointestinal (GI) symptoms.

Methods: Morbidly obese patients undergoing LSG were randomly assigned to have LSG with or without omentopexy from May 2012 to June 2013. A total of 60 patients were recruited with 30 patients in each group. Patients and the symptom-scorer were blinded as to the assigned surgery. All procedures were performed by one of two surgeons (A.P & G.D.). Patients were administered standardized surveys at various time points postoperatively to assess nausea, vomiting, retching, frequency of GI symptoms, and level of distress. All continuous variables were compared using the Mann-Whitney U test.

Results: There was no significant difference in patient age, percent decrease in BMI, or length of hospitalization between the two groups (P>0.05). Furthermore, there was no significant difference (P>0.05) in postoperative GI symptoms between the two groups at baseline, postoperative day 1, 2, 3, 7, and 30 (Table 1). Moreover, the percent change in total symptoms from day 1 compared to days 2, 3, 7, and 30 was also not significantly different (P>0.05). Patients in the LSG with omentopexy group required significantly more Ondansetron perioperatively (16.1±12.9 mg vs. 10.3±10.2 mg, respectively; P=0.04); however, there was no difference in metoclopramide requirement (P=0.22) (Table 2). Finally, there was no significant difference in number of postoperative clinic visits, office telephone encounters, total postoperative readmissions, or postoperative readmissions associated with GI symptoms (P>0.05) (Table 2).

Conclusions: Omentopexy did not significantly decrease postoperative GI symptoms in morbidly obese patients undergoing LSG in the first 30 days. Moreover, these patients had a slightly higher postoperative pharmacologic antinausea requirement compared to those patients undergoing LSG without omentopexy.

Table 1