Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study

Abstract

BackgroundGastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient’s life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications.MethodsPatients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperative recorded parameters were: operative time, estimated intraoperative bleeding, conversion rate. We prospectively evaluated the presence of early complications after LSG during the follow up period. Overall complications were analyzed. Perioperative data and weight loss were also evaluated. A control group was identified for the study.ResultsGroup A (treated with omentopexy with Glubran®2) included 96 cases. Control group included 90 consecutive patients. There were no differences among group in terms of age, sex and Body Mass Index (BMI). No patient was lost to follow-up for both groups. Overall complication rate was significantly reduced in Group A. Mean operative time and estimated bleeding did not differ from control group. We observed three postoperative leaks in Group B, while no case in Group A (not statistical significancy). We did not observe any mortality, neither reoperation. Weight loss of the cohort was similar among groups. In our series, no leaks occurred applying omentopexy with Glubran®2.ConclusionOur experience of omentopexy with a modified cyanoacrylate sealant may lead to a standardized and reproducible approach that can be safeguard for long LSG-suture rime.Trial registrationRetrospective registration on clinicaltrials.gov PRS, with TRN NCT03833232 (14/02/2019).

Laparoscopic Sleeve Gastrectomy with Omentopexy: Is It Really a Promising Method?—A Systematic Review with Meta-analysis

“…Heterogeneity between studies was significantly high (l2 92%). We observed that there is a noticeable difference in time range: Pilone et al reported LOS in days (4.5 versus 5.8), but Hassan et al reported in hours (32+/−9 versus 40+/−8) [13,16]. The difference may depend on the method of calculating the length of stay in the hospital and on well-developed outpatient care in accordance with the ERAS protocol [24,25].…”

“…Sharma et al, in their technique, placed 2-4 sutures at the site proximal to incisura and one suture at the most distal end of staple line [14]. Pilone et al, after formation of the sleeve, applied a layer of the synthetic sealant on all rime sutures and cover it by an omentum flap [13]. In Batman et al, omentopexy is performed by suturing the omentum back to the greater curvature with V-Loc sutures along the entire staple line [17].…”

Remodifying Omentopexy Technique Used With Laparoscopic Sleeve Gastrectomy: Does It Change Any Outcome?

“…Omentopexy during Laparoscopic sleeve gastrectomy, is one method amongst others that have been hypothesized to reduce the various complications Laparoscopic sleeve gastrectomy has been associated with, for example, gastric leaks, gastric obstruction due to strictures or rotation, and gastrointestinal complaints. A consensus has not been reached currently regarding this hypothesis, as current studies show mixed results, some favorable, while others no significant outcome (4) . This prospective randomized controlled clinical trial study was conducted in the Zagazig University hospital including 30 patients with morbid obesity who were admitted to the General Surgery Department, for intervention surgery with laparoscopic sleeve Gastrectomy during the period from July 2020 to August 2021 to assess the safety & feasibility of the omentopexy technique in Laparoscopic sleeve gastrectomy.…”

Chronic rhinosinusitis due to cyano-acrylic glue after endoscopic transsphenoidal pituitary surgery

“…In fact, the longer the chain of the cyanoacrylate is, the less cytotoxic adhesion [3]. The use of Glubran®2 has been expanded as a duroplasty glue [2], Omentopexy and abdominal hernia fixation [6], bronchopleural fistula sealing [7], for decreasing alveolar air leak in thoracic surgery [8] and brain tumors embolization. [4].…”