Pedicled Omentoplasty for Treatment of Rheumatoid Nodule Pneumothorax: A Case Report.

Background No consensus exists regarding surgical intervention for rheumatoid nodule-related pneumothorax. Clinical policy decisions rely on individual clinicians' experience and are usually intractable. Case Description A 50-year-old man with a difficult-to-treat rheumatoid arthritis-related pneumothorax was successfully treated with pedicle omentoplasty without recurrence at approximately 2 years posttreatment. To the best of our knowledge, this is the first report of a patient where pneumothorax did not recur due to firm adhesions despite fluctuating postoperative rheumatoid nodules, as captured by regular computed tomography imaging follow-ups. Conclusion Pedicled omentoplasty is effective for rheumatoid nodule-related pneumothorax as it reduces pneumothorax recurrence.

The Role of Surgery in the Management of Radiation-Induced Brachial Plexopathy.

Radiation-induced brachial plexopathy (RIBP) is a rare long-term complication of radiation therapy often causing pain, motor deficit, and overall quality of life reduction for affected patients. While a standard treatment for RIBP is yet to be established, management consists mostly of symptom management through the use of medications and physical therapy. There is a lack of evidence regarding the efficacy of surgical treatment. Omentoplasties and other vascularized flaps are commonly discussed options for eliminating neuropathic pain associated with RIBP. However, these approaches show no meaningful improvement in motor function. While limited, current literature suggests that nerve transfers may be an option for relief of neuropathic pain as well as restoration of motor function. This review of literature explores the options available to those affected by RIBP with a focus on the role of surgery.

Post-myomectomy omental infarction: a case report.

BACKGROUND: Omental Infarction (OI) is uncommon and mimics common causes of acute abdomen. It is important to differentiate it from other abdominal conditions that require emergency management. It was first reported in literature in 1896 and about 400 cases have been reported till date. CASE PRESENTATION: We reported on a 41 year-old Para 0+0 Ibo house wife who presented with 10 years history of supra-pubic mass and five months history of excessive menstrual flow. After physical examination, a diagnosis of symptomatic uterine fibroid was made. She had myomectomy and the raw surface created after the excision of the myomas was covered with omentum. Wound infection developed on the 8th post-operative day leading to a wound breakdown and later partial extrusion of infarcted omental tissue through the dehisced wound. During re-exploration, the infarcted omental tissue was extracted and the residual abdominal abscess was drained. Surgical site wound infection occurred on the 3rd day after re-operation and a sub-acute intestinal obstruction developed on the 4th day thereafter which responded to conservative management. CONCLUSION: Careful surgical technique is imperative when utilizing the omentum for reconstructive abdominal surgery. Torsion of the omentum and creation of excess tension while using the omentum for reconstructive procedures should be avoided and increase awareness of this uncommon disease condition by the surgeon is also important. This case is to report a rare finding of omental infarction following myomectomy.

Anterior chest wall resection and reconstruction due to recurrent chondrosarcoma: a case report.

Chest wall chondrosarcoma is a rare malignant tumor with aggressive biological behavior. The only available treatment for primary or recurrent chondrosarcoma consists of radical surgical resection because of its well-known chemo- and radioresistance. Repeated resection for recurrent chondrosarcoma is challenging because of the altered anatomy, scarring, harvested muscles, and close proximity to vital thoracic organs. We present an uncommon case of recurrent chest wall chondrosarcoma resected in the Department of Thoracic Surgery, which we reconstructed with Symbotex mesh and reinforced by omentoplasty. In addition, we created a brief review of the prevalence, diagnostics, surgical treatment, reconstructive options, and prognosis for this condition.

Successful combined laparoscopic and thoracoscopic surgery for esophago-mediastinal fistulae.

Minimally invasive surgeries have been developed, not only for gastrointestinal cancer, but also for benign or emergency cases. We report the case of a 62-year-old male who underwent laparoscopic and thoracoscopic combined surgery for an esophago-mediastinal fistula caused by a press-through package. In the initial laparoscopic phase, transhiatal dissection of the lower thoracic esophagus and harvesting of the greater omentum were performed. In the thoracoscopic phase, resection of the fistula and esophageal wall closure were performed. Thereafter, the greater omentum was lifted via the esophageal hiatus and wrapped around the repaired part of the esophagus for reinforcement. The total operative time was 371 min, with 163 and 208 min for the laparoscopic and thoracoscopic phases, respectively. In total, 20 ml of blood was lost. No perioperative complications or recurrences were observed. Laparoscopic and thoracoscopic combined omentoplasty was effective for refractory esophago-mediastinal fistula.

Spontaneous closure of a metachronous brochopleural fistula after omentoplasty for a preceding fistula: Case report.

Introduction: A bronchopleural fistula (BPF) after an anatomical lung resection commonly arises singly. We report a case of a metachronous BPF, which developed after omentoplasty of a preceding fistula and subsequently closed without any intervention. Case presentation: A 77-year-old patient underwent omentoplasty for a brochopleural fistula (BPF) following a right lower lobectomy. A sudden massive air leak developed from the novel BPF approximately 1 cm proximal to the preceding fistula 3 days later. The air leak resolved spontaneously without any intervention one week later. The corresponding fistula was found to be completely closed. Computed tomography showed the omental flap covered both fistulae. Conclusion: The present case suggested that a metachronous BPF could develop and a harvested omental flap might migrate even after being anchored.

Omentoplasty to reduce anastomotic leak in colorectal surgery: a meta-analysis.

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.

[Additional vascularization of the omental flap using mammary-gastroepiploic bypass grafting in the treatment of deep sternal wound infection]. / Mammaro-gastroepiploichnoe shuntirovanie kak sposob dopolnitel'noi vaskulyarizatsii transplantata pri torakoomentoplastike u patsienta so sternomediastinitom.

Incidence of postoperative sternomediastinitis depends on various risk factors and makes up 8%. Surgical debridement with local management of the wound are used to achieve wound sterility. In some cases, sternectomy or subtotal sternal resection are performed for total sternal osteomyelitis with osteoporotic bone and multiple fractures. This procedure results an extensive bone defect. The final stage is anterior chest wall reconstruction. The most popular method is wound closure with autologous muscle or omental flaps. The authors describe a patient with sternomediastinitis who underwent staged treatment. At the final stage, subtotal sternectomy with simultaneous omentoplasty were performed. Additionally, mammary-gastroepiploic bypass grafting with right internal mammary artery and right gastroepiploic artery was carried out for additional vascularization of the omental flap. We found no similar surgery for sternomediastinitis in the literature. Long-term treatment outcome was followed-up (>50 months of relapse-free period and good quality of life).

Intrathoracic transposition of the omentum.

Complex chest and lung infections with bronchial fistula are life-threatening situations with a mortality rate of up to 20%. If medical treatment fails, these patients require aggressive procedures to heal. Transposition of the omentum is a valuable, nonstandard option in these complex cases with aggressive infection involving the pleural space, with or without a bronchial fistula, when medical treatment is unsuccessful. We present a 29-year-old female patient diagnosed with primary immunodeficiency and invasive fungal infection with involvement of the left upper lobe and mediastinal and vertebral bodies treated with a lobectomy and intrathoracic transposition of the omentum.

[Multi-component multi-stage treatment of a patient with infection of thoracic aorta prosthesis, deep sternal wound infection and soft tissue deficit of the chest]. / Mnogokomponentnoe, mnogoetapnoe lechenie patsientki s infektsiei proteza vsei grudnoi aorty, osteomielitom grudiny i defitsitom myagkikh tkanei grudnoi kletki.

We report a comorbid patient after redo Frozen Elephant Trunk procedure followed by recurrent infection of thoracic aortic prosthesis, deep sternal wound infection and extensive soft tissue defect. Closure with skin-muscle thoracodorsal flap and graft-sparing technique with omentoplasty is an alternative to total graft replacement for thoracic aortic graft infection in comorbid patients with concomitant extensive defect of the chest wall or recurrent infection in early postoperative period.

[Treatment of recurrent traumatic sternomediastinitis after cardiac surgery]. / Lechenie retsidivnogo travmaticheskogo sternomediastenita posle kardiokhirurgicheskikh operatsii.

OBJECTIVE: To assess the possibilities of omentoplasty for prevention of complications after redo sternum osteosynthesis for traumatic rupture. MATERIAL AND METHODS: The study included 53 patients with recurrent sternal diastasis. Greater omentum was additionally implanted in 19 (35.8%) cases to improve healing and reduce the risk of infectious complications. In 34 patients, redo osteosynthesis was carried out using a metal wire and deployment of irrigation-aspiration system. In 19 patients, omentoplasty was additionally used to close the wound. RESULTS: Omentoplasty was characterized by less duration of lavage (7.4±1.5 vs. 4.2±3.3 days, p<0.0001) and no cases of arrosive bleeding (p=0.04). CONCLUSION: Omentoplasty reduces duration of treatment and risk of arrosive bleeding.

Usefulness of Omentoplasty to Reduce Perineal Wound Complications in Abdominoperineal Resection After Neoadjuvant Chemoradiotherapy.

BACKGROUND: Omentoplasty is sometimes used to prevent perineal wound complications after abdominoperineal resection (APR) following neoadjuvant chemoradiotherapy (NACRT). However, recent studies have raised some controversy about its clinical benefit. PATIENTS AND METHODS: Outcomes for rectal cancer patients who received APR after NACRT were retrospectively compared between the groups with omentoplasty (n=28) and without omentoplasty (n=14). RESULTS: The operative time was significantly longer in the omentoplasty group (575 vs. 404 min, p<0.001). Laparoscopic surgery was performed more frequently in the omentoplasty group. Perineal wound problems including dehiscence and infection were significantly reduced in the omentoplasty group (46.4% vs. 78.6%, p<0.001). Univariate and multivariate analyses revealed that omentoplasty was the most important factor in reducing perineal wound complications (odds ratio=0.020, 95% confidence intervaI=0.001-0.393; p=0.001). CONCLUSION: Omentoplasty was useful in reducing perineal wound complications after APR following NACRT.

The efficacy of laparoscopic lauromacrogol sclerotherapy in the treatment of simple hepatic cysts located in posterior segments: a refined surgical approach.

BACKGROUND: Hepatic cysts in located posterior segments close to the diaphragm (IVa, VII, and VIII) reportedly have a high recurrence rate. Presently, laparoscopic omentoplasty is the accepted technique; developed from laparoscopic deroofing, which places a viable pedicle flap of omentum to prevent cyst closure. However, potential adhesions have made laparoscopic omentoplasty less favorable. In this paper, we report on an improved surgical technique involving lauromacrogol sclerosis directly under laparoscopic fenestration. We also review and evaluate the efficacy and feasibility of this refined surgical approach. METHODS: Data from 49 patients admitted to the Department of Hepatobiliary Surgery at the Affiliated Hospital of Jiangnan University from October 2015 to June 2020 with simple hepatic cysts located in the IVa, VII, and VIII segments were retrospectively analyzed. All patients were symptomatic before admission. They were separated into two groups based on the surgical approach they had received; refined laparoscopic lauromacrogol sclerotherapy or laparoscopic omentoplasty, and were compared and evaluated in terms of the postoperative cyst volume and quality of life. RESULTS: No significant differences in sex, age, preoperative cyst volume, surgery duration, hospital stay, and bleeding volume were reported. There were no deaths or major complications in both groups. The postoperative cyst volume was significantly reduced in the laparoscopic lauromacrogol sclerotherapy group (2.48 cm) compared to the laparoscopic omentoplasty group (3.90 cm). This study evaluated both the immediate and medium-term results with a 3-12 months follow-up period for all patients. The cyst volume change in the laparoscopic lauromacrogol sclerotherapy group was found to be significantly greater than that of the laparoscopic omentoplasty group. The feedback regarding quality of life did not vary significantly between the two groups, except for general health and health change, where patients who received laparoscopic sclerotherapy responded with higher scores. CONCLUSIONS: Our results indicate that laparoscopic lauromacrogol sclerotherapy surgery was safe and effective in patients with IVa, VII and VIII segment simple hepatic cysts.

Optimizing omentoplasty for management of chronic pelvic sepsis by intra-operative fluorescence angiography: a comparative cohort study.

AIM: Pelviperineal wound complications frequently occur after salvage surgery for chronic pelvic sepsis despite using an omentoplasty. Sufficient perfusion of the omentoplasty following mobilization is essential for proper healing. This study investigated the impact on short-term clinical outcomes of fluorescence angiography (FA) using indocyanine green for assessment of omental perfusion in patients undergoing salvage surgery. METHOD: This was a comparative cohort study including consecutive patients who underwent combined abdominal and transanal minimally invasive salvage surgery with omentoplasty at a national referral centre for chronic pelvic sepsis between December 2014 and August 2019. The historical and interventional cohorts were defined based on the date of introduction of FA in April 2018. The primary outcome was pelviperineal non-healing, defined by the presence of any degree of pelviperineal infection at the final postoperative evaluation. RESULTS: Eighty-eight patients underwent salvage surgery with omentoplasty for chronic pelvic sepsis, of whom 52 did not have FA and 36 did have FA. The underlying primary disease was Crohn's disease (n = 50) or rectal cancer (n = 38), with even distribution among the cohorts (P = 0.811). FA led to a change in management in 28/36 (78%) patients. After a median of 89 days, pelviperineal non-healing was observed in 22/52 (42%) patients in the cohort without FA and in 8/36 (22%) patients in the cohort with FA (P = 0.051). Omental necrosis was found during reoperation in 3/52 and 0/36 patients, respectively (P = 0.266). CONCLUSION: After introduction of FA to assess perfusion of the omentoplasty, halving of the pelviperineal non-healing rate was observed in patients undergoing salvage surgery for chronic pelvic sepsis.

Laparoscopic Sleeve Gastrectomy with T-Shaped Omentoplasty: Impact on the Early Postoperative Outcomes.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure, yet can be followed by complications such as staple line leak and bleeding, vomiting, and gastroesophageal reflux disease (GERD). Various attempts have been described in the literature to improve the early outcome of LSG through various measures. This study aimed to assess the impact of adding T-shaped omentoplasty to LSG on the short-term outcome of the procedure. METHODS: This was a retrospective cohort study on patients with morbid obesity who underwent LSG in the period of November 2015 to November 2018. The outcome of patients with morbid obesity who underwent LSG combined with T-shaped omentoplasty (group I) was compared with that of a similar number of patients who underwent classical LSG without staple line fixation (group II). The main outcome measures were the rates of staple line bleeding and leak, postoperative nausea and vomiting (PONV), GERD, gastric axial rotation, other complications, and weight loss. RESULTS: The study included 106 patients of a mean BMI of 49.8 kg/m2. Group II had significantly higher PONV) scale at 1 week and 1 month than group I. Group I had significantly lower rates of staple line bleeding (0 vs 9.6%, p = 0.02) and GERD (3.7% vs 17.3%, p = 0.02) than group II. Both groups had similar rates of staple line leak and comparable operation time. CONCLUSION: Staple line fixation using the T-shaped omentoplasty technique was associated with lower incidence of significant PONV, staple line bleeding, and GERD as compared with classical LSG.

Plicated Sleeve Gastrectomy with Combined Mesocolon and Greater Omentum Fixation After T-Shaped Omentoplasty: How to Do it?

INTRODUCTION: This technique aims to evaluate fixation of the sleeved distal part of the stomach to the root of the transverse mesocolon and greater omentum after its shortening in a T-shaped design. METHODS: Sleeve gastrectomy is done in a standard five-port technique. Then, we fix the distal end of the staple line using an inverting interrupted 2/0 Ticron suture. We plicate the anterior and posterior walls to invert the staple line and then fix it to the mesocolic fat below the pancreas and to the edge of the disconnected distal omentum close to the antrum. Proceeding caudally, we shorten the greater omentum in the form of a T-shaped suture that forms an omental window between the two edges of the omentum. Plication and fixation are continued upwards until the lower border of the pancreas. Then, we plicate the sleeved stomach using a 2/0 Ticron suture starting cranially near the angle of His. RESULTS: All patients are discharged from the hospital the next day and followed-up at the clinic after the end of first and second weeks, then after 3, 6, and 12 months postoperatively. CONCLUSION: Plicated sleeve gastrectomy combined with mesocolon and greater omentum fixation after T-Shaped omentoplasty is safe and feasible. Long-term follow-up study is required to validate our results.

Omentoplasty Decreases Leak Rate After Esophagectomy: a Meta-analysis.

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.

Retrospective Review of Complications of Liver Hydatid Cyst Surgery with Emphasis on Outcomes of Omentoplasty.

BACKGROUND: The outcome and complications of liver hydatid cyst surgeries with new and old techniques are not well determined. We intended to present the results of operations done for patients with hepatic hydatid cyst in an endemic area. METHODS: Data of 112 patients referred and operated for liver hydatid cyst, in Imam Khomeini Hospital complex, Tehran, Iran, from 2015 to 2018, were collected including demographic characteristics, operation parameters and complication related statistics. The variables were presented for different surgical methods including operations with and without omentoplasty. RESULTS: Patients aged 39. 3 ± 13. 9 yr (70 females; 63. 5%). Most frequent clinical complaint was vague abdominal pain (n=45; 40. 2%). The most prevalent comorbidity was hypertension (18; 16.0%). Conservative methods were chosen more frequently including omentoplasty (44; 39. 3%), cyst drainage (27; 24. 1%), cyst resection (19; 17%) and marsupialization (3; 2. 7%). Overall, 56 patients (50%) were operated with omentoplasty as the single method or in combination with segmentectomy. Complications occurred less in patients operated with omentoplasty (41. 1 vs. 23. 2%; P=0. 043); particularly, biloma was more frequent in surgeries without omentoplasty (7. 1 vs 0. 0%; P=0. 042). Persistence and recurrence rates were 12. 5% and 3. 6% with relative predilection in, respectively, segmentectomy and lobectomy surgical methods compared to Omentoplasty. No mortality was recorded. CONCLUSIONS: In our case series of hepatic hydatid cyst patients, omentoplasty was safe with less complication and similar long-term recurrence rate.

CT assessment of the quality of omentoplasty and its implications for perineal wound healing.

PURPOSE: This study was designed to examine the impact of an omentoplasty and its quality on pelviperineal morbidity after abdominoperineal resection (APR) for rectal cancer. METHODS: This was a retrospective single-centre study of consecutive patients undergoing APR for primary or recurrent rectal cancer between 2000 and 2018. Quality of omentoplasty was categorised (sufficient vs insufficient) based on postoperative CT scans. Main study endpoints were perineal wound healing and perineal hernia. RESULTS: This study included 100 patients: 16 with a sufficient omentoplasty, 16 with an insufficient omentoplasty, and 68 without omentoplasty. Rate of pelviperineal complications within 30 days was 44%, 69% and 64% (P = 0.283), and delayed wound healing at 3 months was 19%, 54% and 27%, respectively (P = 0.109). Sufficient omentoplasty was not significantly associated with less delayed healing in multivariable analysis (OR 0.597; 95% CI 0.149-2.397). An insufficient omentoplasty demonstrated significantly higher rates of delayed healing at 6 months (46% vs 14%; P = 0.016) and chronic perineal sinus at 12 months (31% vs 3%; P = 0.008) compared with no omentoplasty. CONCLUSION: This relatively small series suggest that even a sufficient omentoplasty, as determined by postoperative imaging, does not reduce pelviperineal morbidity after APR for rectal cancer. The methodology of CT-based assessment of an omentoplasty as well as the correlation with postoperative outcomes has to be validated in future studies.