Omentoplasty to reduce anastomotic leak in colorectal surgery: a meta-analysis
Author(s)
Sahebally, SM
Chan, E
Azmir, A
Lu, CT
Doudle, M
Naik, A
Nolan, G
Von Papen, M
Year published
2022
Metadata
Show full item recordAbstract
Background: Anastomotic leaks (AL) remain a devastating complication following intestinal anastomoses resulting in increased morbidity and mortality. Wrapping the anastomosis with omentum may be protective although data are conflicting. We performed a meta-analysis to assess the effect of omentoplasty on colorectal anastomoses. Methods: PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until August 2021. All randomized controlled trials (RCT) that reported on the use of omentoplasty in colon and rectal surgery were included. The primary outcome was rate of overall AL while secondary ...
View more >Background: Anastomotic leaks (AL) remain a devastating complication following intestinal anastomoses resulting in increased morbidity and mortality. Wrapping the anastomosis with omentum may be protective although data are conflicting. We performed a meta-analysis to assess the effect of omentoplasty on colorectal anastomoses. Methods: PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until August 2021. All randomized controlled trials (RCT) that reported on the use of omentoplasty in colon and rectal surgery were included. The primary outcome was rate of overall AL while secondary outcomes included clinical and radiological AL, overall reoperation and mortality. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also performed. Results: Four RCTs were included capturing 1067 patients. The mean (SD) age of the cohort was 61.5 (±14.8) years. On random effects analysis, omentoplasty reduced rate of overall (OR 0.43, 95% CI = 0.21–0.87, p = 0.02) and clinical AL (OR = 0.35, 95% CI = 0.15–0.81, p = 0.01). However, there was no difference in radiological AL (OR = 0.77, 95% CI = 0.40–1.47, p = 0.42), overall reoperations (OR 0.48, 95% CI = 0.18–1.32, p = 0.16) or mortality (OR 0.52, 95% CI = 0.12 to–2.18, p = 0.37). On sensitivity analysis, assessing rectal anastomoses only, the results for overall AL remained similar (OR 0.28, 95% CI = 0.12–0.61, p = 0.002). Conclusion: Although omentoplasty appears to reduce the rate of overall and clinical AL, the heterogeneity in the data prevents definitive recommendations from being made. Further well-designed trials are needed to investigate this technique.
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View more >Background: Anastomotic leaks (AL) remain a devastating complication following intestinal anastomoses resulting in increased morbidity and mortality. Wrapping the anastomosis with omentum may be protective although data are conflicting. We performed a meta-analysis to assess the effect of omentoplasty on colorectal anastomoses. Methods: PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until August 2021. All randomized controlled trials (RCT) that reported on the use of omentoplasty in colon and rectal surgery were included. The primary outcome was rate of overall AL while secondary outcomes included clinical and radiological AL, overall reoperation and mortality. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also performed. Results: Four RCTs were included capturing 1067 patients. The mean (SD) age of the cohort was 61.5 (±14.8) years. On random effects analysis, omentoplasty reduced rate of overall (OR 0.43, 95% CI = 0.21–0.87, p = 0.02) and clinical AL (OR = 0.35, 95% CI = 0.15–0.81, p = 0.01). However, there was no difference in radiological AL (OR = 0.77, 95% CI = 0.40–1.47, p = 0.42), overall reoperations (OR 0.48, 95% CI = 0.18–1.32, p = 0.16) or mortality (OR 0.52, 95% CI = 0.12 to–2.18, p = 0.37). On sensitivity analysis, assessing rectal anastomoses only, the results for overall AL remained similar (OR 0.28, 95% CI = 0.12–0.61, p = 0.002). Conclusion: Although omentoplasty appears to reduce the rate of overall and clinical AL, the heterogeneity in the data prevents definitive recommendations from being made. Further well-designed trials are needed to investigate this technique.
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Journal Title
ANZ Journal of Surgery
Note
This publication has been entered as an advanced online version in Griffith Research Online.
Subject
Clinical sciences