Use of omental flap in left-sided hepatectomy for prevention of delayed gastric emptying: a systematic review and meta-analysis

Delayed gastric emptying (DGE) is a widespread complication after left-sided hepatectomy (LSH). The usage of omental flap (OF) in patients after LSH is thought to reduce the incidence of DGE. Therefore, a meta-analysis was performed in order these findings to be explored. Pubmed, Embase and Cochrane Central were searched for studies comparing usage of omental flap to no-OF in patients after LSH. The primary outcome was DGE. Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration). Heterogeneity was assessed using I2 statistics. Odds ratios (OR) were computed for binary endpoints using a random-effects model. 358 patients were included from 7 studies, of which 2 were randomized controlled trials (RCTs). Male sex was predominant (68 %). OF was used for prevention of DGE in 155 cases. In 3 of the studies the greater omentum was divided for the preparation of the flap. DGE (OR 0.10; 95 % CI 0.04-0.23; p < 0.00001; I2 = 0 %) and overall morbidity (OR 0.31; 95 % CI 0.13-0.74; p = 0.008; I2 = 0 %) were significantly reduced in the OF group, compared to the no-OF group. Utilization of omental flap in patients with left-sided hepatectomy significantly reduces the incidence of DGE and overall morbidity, compared to the no-omental flap procedure.