Use of the greater omentum in colorectal surgery.

Abstract

Complications related to impaired healing remain a major challenge in colorectal surgery. This review examines the potentially protective role of the greater omentum in colorectal operations. Review of all reports concerning applications of the greater omentum in colorectal surgery identified through MEDLINE (1966-1997) and other sources. Clinical case studies indicate that an interposition flap of omentum is beneficial in the management of complex rectal fistulas. Pelvic omentoplasty or an omental hammock appears to reduce the incidence of radiation enteropathy in patients receiving pelvic radiotherapy after rectal resection. However, recent research demonstrates that omental wrapping does not "protect" colonic or rectal anastomoses. Nor is there convincing evidence that pelvic omentoplasty promotes primary perineal healing after abdominoperineal resection for cancer, although it may reduce the incidence of perineal wound breakdown. Previous assumptions concerning the omentum are now being rigorously investigated with the aim of defining its true value in colorectal applications. This must be encouraged, especially where use of the omentum increases the magnitude or duration of operations significantly.