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Omentoplasty Decreases Leak Rate After Esophagectomy: a Meta-analysis

  • Tuo Guangxin 
  • Jin Gang 
  • Pang Yao 
  • Wang Wenhao 
  • Zhu Xiaolei 
  • Zhang Hongyi 
  • Yang Yi 
  • Wu Peng 
  • Zhu Zijiang Email author
Original Article

Abstract

Objective

To compare the efficacy of omentoplasty with non-omentoplasty in the prevention of postoperative anastomotic leakage, and to investigate the safety of omentoplasty.

Methods

Literature searches were performed of the Medline, EMBASE, and Cochrane Library databases. Studies that compared the efficacy of omentoplasty and non-omentoplasty after esophagectomy were selected. A meta-analysis was performed on anastomotic leakage, anastomotic stenosis, hospital mortality, and length of hospital stay. Results were reported as odds ratio (OR), weighted mean difference (WMD), or relative risk (RR), with 95% confidence intervals.

Results

Six studies involving a total of 1608 patients met inclusion criteria. Compared with the non-omentoplasty group, the incidence of anastomotic leakage in the omentoplasty group (OR, 0.37; 95% CI, 0.23–0.60; P < 0.0001) was significantly reduced and the length of hospital stay (WMD, 2.13; 95% CI, 3.57–0.69; P = 0.004) was significantly shortened. However, there was no significant difference in the incidence of anastomotic strictures (OR, 0.82; 95% CI, 0.37–1.80; P = 0.61) or in-hospital mortality (OR, 0.61; 95% CI, 0.25–1.51; P = 0.29).

Conclusions

Omentoplasty after esophagectomy is a safe and effective method to prevent anastomotic leakage.

Keywords

Omentoplasty Esophagectomy Anastomotic leakage Meta-analysis 

Notes

Supplementary material

11605_2019_4284_MOESM1_ESM.doc (24 kb)
ESM 1 (DOC 24 kb)

References

  1. 1.
    Rutegard M, Lagergren P, Rouvelas I, Lagergren J. Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol. 2012. 19(1): 99–103.CrossRefGoogle Scholar
  2. 2.
    Lerut T, Coosemans W, Decker G, De Leyn P, Nafteux P, van Raemdonck D. Anastomotic complications after esophagectomy. Dig Surg. 2002. 19(2): 92–8.CrossRefGoogle Scholar
  3. 3.
    Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg. 2005. 27(1): 3–7.CrossRefGoogle Scholar
  4. 4.
    Patil PK, Patel SG, Mistry RC, Deshpande RK, Desai PB. Cancer of the esophagus: esophagogastric anastomotic leak--a retrospective study of predisposing factors. J Surg Oncol. 1992. 49(3): 163–7.CrossRefGoogle Scholar
  5. 5.
    Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg. 2004. 10(2): 71–5.Google Scholar
  6. 6.
    Peracchia A, Bardini R, Ruol A, Asolati M, Scibetta D. Esophagovisceral anastomotic leak. A prospective statistical study of predisposing factors. J Thorac Cardiovasc Surg. 1988. 95(4): 685–91.Google Scholar
  7. 7.
    Chalmers PJ, Newing RK. Influence of omentum transposition on experimental tumors. J Surg Oncol. 1986. 32(3): 135–7.CrossRefGoogle Scholar
  8. 8.
    John H, Buchmann P. Improved perineal wound healing with the omental pedicle graft after rectal excision. Int J Colorectal Dis. 1991. 6(4): 193–6.CrossRefGoogle Scholar
  9. 9.
    Jesus EC, Karliczek A, Matos D, Castro AA, Atallah AN. Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev. 2004. (4): CD002100.Google Scholar
  10. 10.
    Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002. 21(11): 1539–58.CrossRefGoogle Scholar
  11. 11.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986. 7(3): 177–88.CrossRefGoogle Scholar
  12. 12.
    Sepesi B, Swisher SG, Walsh GL, et al. Omental reinforcement of the thoracic esophagogastric anastomosis: an analysis of leak and reintervention rates in patients undergoing planned and salvage esophagectomy. J Thorac Cardiovasc Surg. 2012. 144(5): 1146–50.CrossRefGoogle Scholar
  13. 13.
    Ye P, Cao JL, Li QY, et al. Mediastinal transposition of the omentum reduces infection severity and pharmacy cost for patients undergoing esophagectomy. J Thorac Dis. 2016. 8(7): 1653–60.CrossRefGoogle Scholar
  14. 14.
    Zhou D, Liu QX, Deng XF, et al. Anastomotic reinforcement with omentoplasty reduces anastomotic leakage for minimally invasive esophagectomy with cervical anastomosis. Cancer Manag Res. 2018. 10: 257–263.CrossRefGoogle Scholar
  15. 15.
    Zheng QF, Wang JJ, Ying MG, Liu SY. Omentoplasty in preventing anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy. Eur J Cardiothorac Surg. 2013. 43(2): 274–8.CrossRefGoogle Scholar
  16. 16.
    Bhat MA, Dar MA, Lone GN, Dar AM. Use of pedicled omentum in esophagogastric anastomosis for prevention of anastomotic leak. Ann Thorac Surg. 2006. 82(5): 1857–62.CrossRefGoogle Scholar
  17. 17.
    Dai JG, Zhang ZY, Min JX, Huang XB, Wang JS. Wrapping of the omental pedicle flap around esophagogastric anastomosis after esophagectomy for esophageal cancer. Surgery. 2011. 149(3): 404–10.CrossRefGoogle Scholar
  18. 18.
    Thakur B, Zhang CS, Tan ZB. Omentoplasty versus no omentoplasty for esophagogastrostomy after surgery for cancer of cardia and esophagus. Indian J Cancer. 2004. 41(4): 167–9.Google Scholar
  19. 19.
    Zhang QX, Magovern CJ, Mack CA, Budenbender KT, Ko W, Rosengart TK. Vascular endothelial growth factor is the major angiogenic factor in omentum: mechanism of the omentum-mediated angiogenesis. J Surg Res. 1997. 67(2): 147–54.CrossRefGoogle Scholar
  20. 20.
    Adams W, Ctercteko G, Bilous M. Effect of an omental wrap on the healing and vascularity of compromised intestinal anastomoses. Dis Colon Rectum. 1992. 35(8): 731–8.CrossRefGoogle Scholar
  21. 21.
    Jurkiewicz MJ, Arnold PG. The omentum: an account of its use in the reconstruction of the chest wall. Ann Surg. 1977. 185(5): 548–54.CrossRefGoogle Scholar
  22. 22.
    Chen L, Liu F, Wang K, Zou W. Omentoplasty in the prevention of anastomotic leakage after oesophagectomy: a meta-analysis. Eur J Surg Oncol. 2014. 40(12): 1635–40.CrossRefGoogle Scholar
  23. 23.
    Horstmann O, Verreet PR, Becker H, Ohmann C, Roher HD. Transhiatal oesophagectomy compared with transthoracic resection and systematic lymphadenectomy for the treatment of oesophageal cancer. Eur J Surg. 1995. 161(8): 557–67.Google Scholar
  24. 24.
    Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis. Ann Surg. 2011. 254(6): 894–906.CrossRefGoogle Scholar
  25. 25.
    Wiggins T, Markar SR, Arya S, Hanna GB. Anastomotic reinforcement with omentoplasty following gastrointestinal anastomosis: A systematic review and meta-analysis. Surg Oncol. 2015. 24(3): 181–6.CrossRefGoogle Scholar
  26. 26.
    Zhang Z, Xu X, Ni H. Small studies may overestimate the effect sizes in critical care meta-analyses: a meta-epidemiological study. Crit Care. 2013. 17(1): R2.CrossRefGoogle Scholar
  27. 27.
    Nuesch E, Trelle S, Reichenbach S, et al. Small study effects in meta-analyses of osteoarthritis trials: meta-epidemiological study. BMJ. 2010. 341: c3515.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Tuo Guangxin 
    • 1
    • 2
  • Jin Gang 
    • 2
  • Pang Yao 
    • 2
  • Wang Wenhao 
    • 2
  • Zhu Xiaolei 
    • 1
    • 2
  • Zhang Hongyi 
    • 2
  • Yang Yi 
    • 1
    • 2
  • Wu Peng 
    • 1
    • 2
  • Zhu Zijiang 
    • 2
    Email author
  1. 1.Department of Clinical MedicineGansu University of Traditional Chinese MedicineLanzhouPeople’s Republic of China
  2. 2.Department of Thoracic Surgery 2Gansu Provincial HospitalLanzhouPeople’s Republic of China

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