Publication: Use of greater omentum in thoracic onco-surgery
Date
2007
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Background: Omentum is well known for its immunocompetence and good blood supply; and therefore, is being
used in various complex thoracic procedures. Specially, in situations when staplers, sealants and total parenteral
nutrition may not be used because of financial constraints, omentum may prove very helpful in preventing post-
operative fatal complications.
Methods: A retrospective review of 61 patients was undertaken. Patients were categorized into two groups. In group
I, omentum was sutured to the anastomosis for prophylaxis of leak from gastro-oesophagectomy after radical
surgery for cancer of cardia and oesophagus. In group II, it was used for therapeutic purpose, to control diffuse air
leak from lung parenchyma after chest wall and invaded lung resection for malignant chest wall tumours (subgroup
A) and treatment of post pneumonectomy bronchopleural fistula for NSCLC of right lung (subgroup B). Gastro-
oesophagectomy, closure of bronchial stump and suturing of lung parenchyma after wedge resection was done with
manual suturing technique only.
Results: Group I: There were 57 patients with the diagnosis of cancer of cardia and oesophagus, who underwent
radical surgery. Transthoracic approach was used in 96.5% patients, whereas 3.5% patients underwent transhiatal
resection. Anastomotic level was located in chest in 68.4% and in neck in 31.6% patients. The leakage rate was
5.4%. Group II: There were three patients in subgroup A, all with lesions located in left side of chest wall. There
was one patient in subgroup B. Chest tube was removed after a mean time of 2 days and after 4 days in subgroup A
and B, respectively. There was 1 mortality (1.6%) secondary to chylothorax.
Conclusion: Use of pedicled omentum appears to be a very simple technique to prevent the anastomotic leak after
radical surgery for cancer of cardia and oesophagus, and to seal the diffuse parenchymal pulmonary leak after
various procedures in thorax.
Key words: greater omentum; omentoplasty; omentopexy
Description
Thakur B1, Zhang CS 2, Cao FM 3
1 Department of Surgical Oncology, BP Koirala Memorial Cancer Hospital, Bharatpur, 2The Cancer Hospital ofXingtai City, Xingtai, Hebei, China, 3The 4 th Hospital of Hebei Medical University, Shijiazhuang, China