What Is the Omentum?

The omentum is the fatty tissue that secures the intestines and other abdominal organs in place, supplying them with blood along with physically protecting them.The omentum is the fatty tissue that secures the intestines and other abdominal organs in place, supplying them with blood along with physically protecting them.

The omentum ("policeman of the abdomen") is a double layer of fatty tissue that covers and supports the intestines and organs in the lower abdomen. The omentum comprises the greater omentum which is important storage for fat deposits and the lesser omentum which holds the stomach and intestines in place next to the liver and connects them via blood vessels.

What is omentoplasty?

Omentoplasty is a surgical procedure in which part of the greater omentum is used to cover or fill a defect, improve arterial or venous circulation, decrease effusion (fluid accumulation) or increase lymphatic drainage. 

Why is omentoplasty done?

Omentoplasty has been used in various settings involving conditions within and outside the abdomen. Omentoplasty is indicated for the following cases:

  • Gastrointestinal: Hydatid disease of the liver (fluid-filled cyst containing parasites in the liver), perforated peptic ulcer, surgically treatable pancreatic and intestinal conditions
  • Gynecologic: After abdominal hysterectomy, vesicovaginal fistulae, vaginal reconstruction
  • Vascular: Revascularization in vascular diseases
  • Cardiothoracic: Infections in the chest, chest-wall reconstruction
  • Reconstruction: Throat reconstruction, filarial lymphedema of the leg

When should omentoplasty be avoided?

Omentoplasty may be contraindicated in the following conditions:

  • Presence of advanced intra-abdominal tumors
  • Unavailability of a sufficient length of omentum for the procedure being planned. 
    • This may be due to prior intra-abdominal infections or previous surgical procedures.
  • Poor blood supply of the omentum
  • Poor health status of the patient

How is omentoplasty performed?

Before the surgery

  • The surgeon performs a complete physical assessment. 
  • Complete blood and radiological tests are performed, and the consent is obtained from the patient prior to surgery.

During the surgery

  • Omentoplasty may be classified into the following two types 
    • Type I – Single-layered omentum
    • Type II – Double-layered omentum
  • The surgery is performed under general anesthesia.
  • In this procedure, part of the colon and stomach are removed from the abdomen through a surgical incision. 
  • The greater omentum is then detached from the colon and stomach. 
  • The arterial pattern of the omental vessels is carefully studied once the omentum has been fully mobilized. 
  • The omentum is then lengthened by dividing it according to the anatomic pattern of the vessels. 
  • The omentum is then transplanted to the site required. 
  • The final step of the procedure is surgical wound closure. The abdomen is closed in layers. 
  • A surgical drain may be inserted to drain fluid and blood accumulation. 
  • After cleaning all of the wounds with an antiseptic solution, sterile dressings are applied.

After the surgery

  • The patient is usually discharged three to seven days after surgery. 
  • The patient is administered with painkillers and antibiotics. 
  • The surgical drain is removed 24 to 48 hours after surgery. 
  • Pain, swelling and bruising is normal in the postoperative period; it usually resolves in about two weeks.

What are the complications of omentoplasty?

Some complications of omentoplasty are:

  • Ileus (paralysis of the intestine)
  • Infection
  • Abscess formation (pus accumulation)
  • Intestinal obstruction
  • Necrosis (tissue death) of the omental flap
  • Abdominal hernia (abnormal protrusion of an organ or other piece of tissue through a weakening in the muscle walls of the abdominal cavity)

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