Laparoscopic sleeve gastrectomy (LSG) can cause gastric twist/torsion, gastroesophageal reflux disease (GERD), and prolonged postoperative nausea and vomiting (PONV). In addition, bleeding and leaks are the most feared complications in the early postoperative period. Various staple line reinforcement (SLR) techniques have been innovated to reduce the incidence of bleeding and leaks; as oversewing (OS), omentopexy/gastropexy (OP/GP), buttressing, and gluing. OP/GP isn’t only an SLR method that is used for prevention of bleeding and leaks, but also a staple line fixation method that few surgeons use to prevent gastric twist/torsion, and motility related complications as GERD and prolonged PONV. The goal of this study is to compare postoperative outcomes between LSG with OP/GP and LSG without OP/GP or any other SLR method. Key points • OP/GP decreases, leaks, bleeding, readmissions, prolonged PONV, gastric twist/torsion, and GERD. This was consistent in all studies (no heterogeneity). • OP/GP appears to decrease length of stay and prolonged antacids use at 12 months postoperatively, but this isn’t on solid ground due to significant heterogeneity observed among studies. • The only disadvantage of OP/GP is the increase in operative time.