The effect of omentoplasty in various surgical operations: systematic review and meta-analysis

Abstract

Background: Omentoplasty is commonly used in various surgeries. However, its effectiveness is unsure due to lack of convincing data and research. To clarify the impact of omentoplasty on postoperative complications of various procedures, this systematic review and meta-analysis was performed.

Methods: A systematic review of published literatures from four databases: PubMed, Web of Science, Cochrane Library, and Embase before 14 July 2022. The authors primarily included publications on five major surgical operations performed in conjunction with omentoplasty: thoracic surgery, esophageal surgery, gastrointestinal surgery, pelvi-perineal surgery, and liver surgery. The protocol was registered in PROSPERO.

Results: This review included 25 273 patients from 91 studies ( n =9670 underwent omentoplasty). Omentoplasty was associated with a lower risk of overall complications particularly in gastrointestinal [relative risk (RR) 0.53; 95% CI: 0.39-0.72] and liver surgery (RR 0.54; 95% CI: 0.39-0.74). Omentoplasty reduced the risk of postoperative infection in thoracic (RR 0.38; 95% CI: 0.18-0.78) and liver surgery (RR 0.39; 95% CI: 0.29-0.52). In patients undergoing esophageal (RR 0.89; 95% CI: 0.80-0.99) and gastrointestinal (RR 0.28; 95% CI: 0.23-0.34) surgery with a BMI greater than 25, omentoplasty is significantly associated with a reduced risk of overall complications compared to patients with normal BMI. No significant differences were found in pelvi-perineal surgery, except infection in patients whose BMI ranged from 25 kg/m 2 to 29.9 kg/m 2 (RR 1.25; 95% CI: 1.04-1.50) and anastomotic leakage in patients aged over 60 (RR 0.59; 95% CI: 0.39-0.91).

Conclusion: Omentoplasty can effectively prevent postoperative infection. It is associated with a lower incidence of multiple postoperative complications in gastrointestinal and liver surgery.

Figure 1

PRISMA (preferred reporting items for systematic reviews and meta-analyses) 2020 flow diagram for systematic reviews shows the procedure of literature search and processing of this study. Initially, reviewers identified relevant records using the strategy described in the methods section and manually and automatically excluded duplicates. Secondly, reviewers screened records for their titles and abstracts before excluding those that did not pertain to the study. Finally, reviewers evaluated the eligibility of the retrieved reports by examining the full text, and 91 of the studies met the criteria. This review included a total of 92 studies, one of which was included in the previous review.

Figure 2

Meta-analysis of postoperative results of gastrointestinal surgery with or without omentoplasty. (A) Forest plot illustrating the incidence of postoperative bleeding after gastrointestinal surgery in a fixed-effects model. (B) Forest plot illustrating the incidence of anastomotic leak after gastrointestinal surgery in a fixed-effects model. (C) Forest plot illustrating the subgroup analysis of BMI on the incidence of fistula after gastrointestinal surgery in a fixed-effects model. Patients whose BMI was over 25 were not included in this subgroup analysis due to a lack of data. OP, omentoplasty; non-OP, nonomentoplasty.

Figure 3

Meta-analysis of postoperative results of liver surgery with or without omentoplasty. (A) Forest plot illustrating the incidence of infection after liver surgery in a fixed-effects model. (B) Forest plot illustrating the incidence of recurrence after liver surgery in a fixed-effects model. (C) Forest plot illustrating the subgroup analysis of age on mortality after liver surgery in a fixed-effects model. Patients aged over 60 were not included in this subgroup analysis due to a lack of data OP, omentoplasty; non-OP, nonomentoplasty.

Figure 4

Meta-analysis of postoperative results of esophageal surgery with or without omentoplasty. (A) Forest plot illustrating the incidence of overall complications after esophageal surgery in a fixed-effects model. (B) Forest plot illustrating the incidence of infection after esophageal surgery in a fixed-effects model. (C) Forest plot illustrating the incidence of anastomotic leak after esophageal surgery in a random-effects model. (D) Forest plot illustrating the mortality after esophageal surgery in a random-effects model. OP, omentoplasty; non-OP, nonomentoplasty.

Figure 5

Meta-analysis of postoperative results of thoracic surgery with or without omentoplasty. (A) Forest plot illustrating subgroup analysis of age on overall complications after thoracic surgery in a fixed-effects model. Patients aged from 18 to 44.9 were not included in this subgroup analysis due to a lack of data. (B) Forest plot illustrating the incidence of infection after thoracic surgery in a fixed-effects model. (C) Forest plot illustrating the incidence of reoperation after thoracic surgery in a fixed-effects model. (D) Forest plot showing the mortality after thoracic surgery in a fixed-effects model. OP, omentoplasty; non-OP, nonomentoplasty.

Figure 6

Meta-analysis of postoperative results of pelvi-perineal surgery with or without omentoplasty. (A) Forest plot illustrating the subgroup analysis of BMI on the incidence of overall complication after pelvi-perineal surgery in a fixed-effects model. Patients whose BMI was over 30 were not included in this subgroup analysis due to a lack of data. (B) Forest plot illustrating the subgroup analysis of BMI on the incidence of infection after pelvi-perineal surgery in a fixed-effects model. Patients whose BMI ranged from 18.5 to 24.9 or over 30 kg/m² were not included in this subgroup analysis due to a lack of data. (C) Forest plot illustrating the subgroup analysis of age on the incidence of anastomotic leak after pelvi-perineal surgery in a fixed-effects model. Patients aged from 18 to 44.9 were not included in this subgroup analysis due to a lack of data. OP, omentoplasty; non-OP, nonomentoplasty.