Omentopexy for reconstruction of the perineum following a radical vulvectomy: a case report

Application of pedicled greater omentum flap tamponade combined with laparoscopic fenestration in diaphragmatic hepatic cyst

Objective

To investigate the efficacy and clinical application advantage of omental tamponade with vascular pedicle combined with Laparoscopic fenestration for the treatment of diaphragmatic hepatic cyst.

Methods

A total of 56 patients with diaphragmatic hepatic cysts underwent laparoscopic surgery in a single tertiary academic medical center from January 2010 to October 2020, including 21 patients (non-omental group) underwent laparoscopic fenestration of liver cysts, and 36 patients underwent laparoscopic liver cyst fenestration combined with vascular pedicle omentum tamponade (omental group). The general conditions and follow-up results of the two groups were compared and annalyzed.

Results

The operation time of the omental group was longer than that of the non-omental group (P = 1.358E-4). There was no significant difference in postoperative complications, postoperative laboratory values and hospital costs (P>0.05). The length of hospital stay in omental group was shorter than that in non-omental group (P = 0.034). In the omental group, recurrence occurred in 1 of 35 patients (4.65%) who were followeded up 12 months after surgery. In the non-omental group, of the 21 patients followed, 3 patients (14.28%) recurred 6 months after surgery, and 8 patients (38.10%) recurred 12 months after surgery.

Conclusion

It is an effective method to prevent the recurrence of diaphragmatic hepatic cyst after laparoscopic fenestration by packing the cyst with vascularized omentum.

Omentum a powerful biological source in regenerative surgery

The Omentum is a large flat adipose tissue layer nestling on the surface of the intra-peritoneal organs. Besides fat storage, omentum has key biological functions in immune-regulation and tissue regeneration.

Omentum biological properties include neovascularization, haemostasis, tissue healing and regeneration and as an in vivo incubator for cells and tissue cultivation. Some of these properties have long been noted in surgical practice and used empirically in several procedures.

In this review article, the author tries to highlight the omentum biological properties and their application in regenerative surgery procedures. Further, he has started a process of standardisation of basic biological principles to pave the way for future surgical practice.

Omentoplasty in abdominoperineal resection: a review of the literature using a systematic approach

PURPOSE

Abdominoperineal resection is associated with considerable morbidity, in particular, the perineal wound. Omentoplasty has been proposed as a means of reducing the perineal complication rate after abdominoperineal resection. This study was designed to assess the available evidence for omentoplasty in abdominoperineal resection.

METHODS

A MEDLINE search from January 1970 to July 2005 was performed to locate English language articles relating to omentoplasty in abdominoperineal resection. Manual search via reference lists identified additional articles. Articles reporting results from at least ten patients in whom abdominoperineal resection with an omentoplasty was performed were considered. All included reports were reviewed by using a predetermined protocol.

RESULTS

Among the ten reports identified, no randomized trials, four studies with control groups, and six case series were found. Primary healing was the outcome measure that was most consistently reported in the different articles. Most authors reported positive results after omentoplasty, and one study showed significant improvement in perineal healing rate at six months. Significant reduction in sinus formation and wound dehiscence also was reported. Only few complications related to the omentoplasty, none of which was fatal, were reported.

CONCLUSIONS

Although results from the studies included in this review indicate that there may be benefits from including an omentoplasty when performing an abdominoperineal resection, the lack of randomized studies results in only weak evidence.