Omentopexy Research Articles

Laparoscopic Sleeve Gastrectomy with Omentopexy: Is It Really a Promising Method?\u2014A Systematic Review with Meta-analysis

PurposeLaparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedure worldwide. Omentopexy during LSG is a novel variation of this well-established technique. There are no clear conclusions on indications for this procedure, safeness, and effects of such a method. We aimed to compare the outcomes of laparoscopic sleeve gastrectomy (LSG) with omentopexy (OP) and without omentopexy.Materials and MethodsWe searched the Medline, EMBASE, and Scopus databases up-to June 2020. Full-text articles and conference abstracts were included for further analysis. This review follows the PRISMA guidelines.ResultsOf initial 66 records, only 4 studies (N = 1396 patients) were included in the meta-analysis. Our findings showed that LSG with omentopexy had significantly lowered overall morbidity compared to LSG without omentopexy (RR = 0.38; 95% CI [0.15, 0.94]; p=0.04). Gastric leakage rate (RR = 0.17; 95% CI [0.04, 0.76]; p = 0.02) was also significantly lower in LSG with omentopexy. There were no significant differences between groups in length of hospital stay.ConclusionsOur meta-analysis showed that LSG with omentopexy may be a feasible procedure for decreasing morbidity and gastric leak rate. However, despite promising results, the procedure needs to be researched more in randomized controlled studies to draw solid conclusions.

Omentopexy in sleeve gastrectomy and its effect on postoperative complications

Background Sleeve gastrectomy is an effective and relatively safe procedure for morbid obesity. Diagnosis of leakage is mainly based on clinical suspicion rather than laboratory and radiological evidence. Aim To evaluate the benefit of omental reattachment with full-thickness stomach stitches during laparoscopic sleeve gastrectomy (LSG) in decreasing postoperative hemorrhage and/or leakage. Patients and methods A retrospective analysis was conducted on the collected data from 100 cases that were divided into two groups: group I included 50 cases that underwent LSG procedures with no omental reattachment, and group II included 50 cases that underwent LSG procedures with omental reattachment with full-thickness staple line of sleeved stomach stitches till the level of angle of His above and to the antrum below from April 2019 to April 2020 at Bariatric Surgery Unit of the General Surgery Department of Ain Shams University Hospitals. Results There was a statistically significant difference between the two groups regarding the operation time and drain content and amount. There was a decrease of postoperative bleeding between the two groups from 12% in group I to 0% in group II, with P value of 0.4, indicating slight significant difference. It also showed no difference in the percentage of postoperative leakage, as it was 1% in both groups. Conclusion A decrease in incidence of bleeding postoperatively can be achieved by omental fixation to the sleeved stomach by full gastric thickness stitches; it will decrease patient’s morbidity and mortality, as it decreases hospital stay and possibility of blood transfusion.

Remodifying Omentopexy Technique Used with Laparoscopic Sleeve Gastrectomy: Does It Change any Outcomes?

Gastric obstructions, leaks and staple line bleeding are reported after laparoscopic sleeve gastrectomy (LSG). There is no ideal method or technique to avoid these mishaps. We added modifiedomentopexy (OP) to LSG to determine if there is any effect on gastric leaks and some other complications. This single institution case control study included two groups of morbidly obese patients undergoing LSG. They were grouped as omentopexy (OP) or no omentopexy (NP). Patient characteristics such as age, sex, ASA (American Society of Anesthesiologists) risk, body mass index (BMI), nutritional status and comorbidities were comparable. Postoperative follow-up was scheduled at 1week, 1month, 3months, 6months and 12months. All received standard postoperative clinical, nutritional evaluation and PPI therapy for at least 3months. Total 737 patients underwent LSG from January 2012 to December 2017. Out of these, 370 that had OP and 367 that had NP were analyzed. NP group was subdivided into Lemberted Staple line (LS) and bioabsorbable staple line reinforcement (BSLR) groups. Gastric leaks and perforations were clubbed together as gastric disruptions (GD). Patients with at least 15months of postoperative follow-up were included. Those who failed to follow up were excluded. GD was reported in 7 out of 367 NP patients (1.9%), while no GD was seen in 370 OP patients (P = 0.01). Bleeding was seen in 1 OP versus 2 NP patients (P = 0.6). Venous thromboembolism was reported in 2 OP versus 1 NP patients (P = 1). Wound infection was seen in 1 OP versus 2 NP patients (P = 0.6). Readmissions were noted in 2 OP versus 6 NP patients (P = 0.1). Pneumonia was seen in 2 OP and 2 NP patients (P = 1). Postoperative dehydration was seen in zero OP versus 1 NP patients (P = 0.4). Gastric obstruction was not seen in any of the patients. Postoperative gastric reflux was present in 49/370(13.2%) OP versus 57/367(15.4%) NP patients (P = 0.4). Within NP group, LS (Lemberting of Staple line) patients (286/367) had 4 GD (1.39%) versus no GD in OP (P = 0.03). BSLR (Bioabsorbable Staple line re-enforcement) patients (81/367) had 3 GD (3.7%) versus no GD in OP (P = 0.005). None of the groups had any mortality. GD (gastric disruptions) were statistically significant, but the following bleeding, venous thromboembolism and gastroesophageal reflux did not reach statistical significance, which indicates that OP, if performed correctly with LSG, has favorable effects on gastric leaks.

Laparoscopic treatment versus open treatment of gastroduodenal perforations: our decades of retrospective experience and literature review

Background: The aim of our work is to evaluate the laparoscopic treatment of gastroduodenal ul-cers (GDU) perforated in a territory where the population is multiethnic and where, given that the main activity is agriculture, the presence of non-EU citizens (EX) and of Eastern European citizens (EE) is considerably higher. Methods: From January 2007 to December 2017, 97 patients were operated for perforated GDU in our department all treated within 24 h from admission and/or from the beginning of the sympto-matology, 70 males and 27 females, in most cases they were foreign citizens, the average age was 34 for foreigners and 58 for Italians. In total, 68 were treated by laparoscopy (LS) and 25 by laparoto-my (LT), the cases of conversion from LS to LT were 4 included in a third group. Usual direct su-ture accompanied by omentopexy (OP) if ulcer > of 5 mm and/or if it is in the stomach. Results: The majority of patients treated were foreign: 69 (24 EX and 45 EE, age: 18–55), while 28 were Italians (age: 30–86). In the foreigners the most frequent cause was alcohol and smoking: pre-sent in 60 patients, in the remaining 9 the cause is abuse of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. In the Italians 21 had abused in NSAIDs and/or corticosteroids and 7 had GD pathologies not treated. The average hospitalization was 6 days for the LS and 9 for the LT and average duration was 91 minutes in LT and 65 in LS. Conclusions: The gold standard in the treatment of perforated GDU is LS; LS that we can perform in almost all cases treated both because the majority of patients is foreign and has a lower average age compared with Italians and because we have an operating team trained to deal with this disease. 24 h from the symptomatological manifestation has favored us both in terms of endoabdominal col-lections and in the inflammatory state of the perilesional area. In our experience LS treatment is far superior to LT treatment both in terms of patient benefit and health expenditure and combines the advantages of LS with the reliability of LT treatment.

Novel regenerative therapy combined with transphrenic peritoneoscopy-assisted omentopexy.

We previously reported that cell sheet transplantation combined with an omentopexy (OP) procedure is more effective for repairing heart damage when compared with cell sheet transplantation alone. However, a simultaneous (conventional) laparotomy as part of the OP may adversely affect the general condition of critically ill heart failure patients who would otherwise benefit from cell sheet transplantation, which is a paradox to be reconciled before this treatment can be applied in a clinical setting. We devised a novel endoscopic approach termed 'transphrenic peritoneoscopy' (TPP) for minimal access to abdominal organs from the thoracic cavity. Herein, we evaluated the feasibility and safety of TPP with an OP in a porcine myocardial infarction model. Myocardial infarction was induced in 4 mini pigs by placing an ameroid constrictor around the left anterior descending artery. One month later, a left thoracotomy was performed in 2 randomly selected mini pigs, and a laparoscopic port was placed on the left diaphragm to gain access into the abdominal cavity. Using a low-pressure pneumoperitoneum, a flexible gastrointestinal endoscope was advanced, then the omentum was partially grasped with endoscopic forceps and brought back into the thoracic cavity via the diaphragm. Skeletal myoblast cell sheets were then implanted over the impaired myocardium, followed by placing the omentum over the sheets. TPP-assisted OP was accomplished in 2 post-myocardial infarction mini pigs with severe heart failure with an intra-abdominal pressure ≤8 mmHg within 30 min (22 and 27 min, respectively). Necropsy findings revealed a viable omentum flap and pedicle in both animals, with no evidence of procedure-related complications. Angiographic and histological analyses confirmed vessel communication between the omentum and the left ventricle. Our TPP approach was shown to be feasible and safe with a low-pressure pneumoperitoneum, while the omentum flap was durable. This successful combination of techniques may provide less-invasive endoscopic intervention and regenerative therapy.

Commercial polyester/cotton fabric (Damour): a novel prosthetic material for hernioplasty in ruminants.

The aim of this work was to study the possibility of using a new commercial polyester/cotton fabric to repair large sized umbilical and abdominal hernias in calves and small ruminants. Twenty-four animals (16 calves, 3 buffalo calves, 4 sheep, 1 goat) with umbilical or abdominal hernia were included in this study. The diameter of hernial ring ranged from (12-25) cm. An underlay technique was used for fixation of the prosthetic material that was placed under the visceral peritoneum after omentopexy and was secured to the recipient tissue with interrupted overlapped pattern using polypropylene monofilament suture material. After one year follow up, normal healing without complications in 19 animals was revealed (79.82%). Wound infection and delayed healing were recorded in 3 animals (12.5%) and wound dehiscence and re-herniation were observed in 2 cases (8.3%). In conclusion, our results suggested that commercial polyester/cotton fabric (Damour) represents a new cost effective alternative to commonly used meshes for hernioplasty of large sized hernias with relatively low rate of complications and recurrence in calves and small ruminants.

Laparoscopic Sleeve Gastrectomy: One Institution's Experience with Omentopexy in the Prevention of Gastric Leaks (Retrospective Review)

Background: The omentum is associated with accelerated wound healing properties. This IRB-approved multisurgeon single-center study is aimed to evaluate whether complications are reduced by omentopexy (OP) to the staple line after a laparoscopic sleeve gastrectomy. Methods: Adults who have undergone a laparoscopic sleeve gastrectomy at St. Joseph’s Regional Medical Center were reviewed. The group which had the OP performed was compared to the group which did not. Controls were matched for concurrent hiatal hernia repair, degree of obesity, and operating surgeon. OP was only performed by a single surgeon (Surgeon A), however several surgeons performed laparoscopic sleeve gastrectomies. Data extracted included demographics, indication, diagnostic investigations, treatments given, perioperative outcomes, findings, response to treatment given and survival. Complications were defined as a definitive leak or abscess seen on CT or upper GI study. Results: A total of 181 patients underwent a laparoscopic sleeve gastrectomy, of which 75 patients (41%) also underwent OP. 18 patients (9.9%) had a concurrent hiatal hernia repair. Complications were found in 5 patients (2.76%). 4 of the 5 patients who had a complication had underwent OP. Complication rates between the group which had OP and the group which did not have OP showed an OR 6.0571, 95% CI 0.6631 to 55.3280, P 0.1105. No complications were observed in patients who had a concurrent hiatal hernia repair. An association was observed between Surgeon A and increased complications in patients who underwent OP (OR 5.0979, 95% CI 0.2676 to 97.1194, P 0.2787) as well as those who did not undergo OP (OR 1.8271, 95% CI 0.0727 to 45.9307, P 0.7141). An association was also seen between complications and patients who are super obese (OR 1.0833, 95% CI 0.1172 to 10.0126, P 0.9438) and severely obese (OR 2.2319, 95% CI 0.3378 to 14.5153, P 0.3603). No association was seen between complications and patients who are morbidly obese (OR 0.4950, 95% CI 0.0807 to 3.0371, P 0.4474). Limitations: Small sample size, limited patient population, complication rates of a single surgeon performing the omentopexies, comorbidities, as well as limitations of retrospective analysis. Conclusion: OP to the staple line is not associated with decreased overall complication rates. Concurrent hiatal hernia repair was not associated with complications. OP performed in patients who are super obese or severely obese had more complications as opposed to morbidly obese patients who had decreased complications. In addition, OP may be associated with decreased complications only in patients who are morbidly obese. In conclusion, one cannot, in good conscience, continue performing omentopexy given the significantly higher complication rate noted.

Efficacy of Omentopexy with a Peritoneal Window for an Intractable Groin Lymphocele: A Report of Two Cases

鼠径部手術後の難治性リンパ漏に対し，大網充填併用腹膜開窓術による腹腔へのドレナージが有効であった2例を経験した．症例1は87歳，男性．閉塞性動脈硬化症に対する人工血管バイパス後3年目に左鼠径部にリンパのう胞が発症した．数回の穿刺吸引・圧迫治療や癒着療法を行うも再発したため，リンパ液の腹腔への誘導と人工血管の感染防止を目的に，大網を有茎に作成し誘導，治癒し得た．症例2は77歳，男性．鼠径部リンパ節の生検後にリンパ漏が発症，数回の再閉創術や持続陰圧吸引を行うも再発したため，有茎大網を右鼠径部に誘導した．術後速やかにリンパ液の漏出は消失，術後4年の経過は良好である．大網充填併用腹膜開窓術は難治性リンパ漏に対する，侵襲的ではあるが有効な治療法の一つである．

The Effect of Hepatic Hydatid Cysts on the Size of Spleen

ABSTRACT No previous study has yet reported the effects of surgical treatment of hydatid cysts on spleen volume. Our aim was to use computed tomography images to evaluate the volume differences in the spleen in postoperative periods in patients who had undergone operations for hydatid cysts. The abdominal computed tomography scans of 20 patients who had undergone drainage of a hydatid cyst and omentopexy operation were examined retrospectively. The volume of the liver, the cyst, and the spleen were estimated using the Cavalieri principle of stereological methods. The volume fraction of the hydatid cyst to the liver was also estimated using the obtained volume data. The volumes of the spleen (± SD) were 302.0 ± 115.1 cm3 and 259.5±82.4 cm3 in the postoperative 1st week and 6 months, respectively (p 0.05). The volume of spleen decreased after hydatid cyst surgery. This may be due to the decreased portal venous pressure of the liver. Additionally, the loss of immune stimulation may have resulted in reduction in splenic volume. Our results also indicated that stereological methods can be used to monitor volume changes of the liver and spleen. J. Exp. Clin. Med., 2011; 28:8-11

Omentopexy enhances graft function in myocardial cell sheet transplantation

Myocardial cell sheets (MCS) are a potentially valuable tool for tissue engineering aimed at heart regeneration. Several methods have recently been established for the fabrication of MCS. However, the lack of a sufficient blood supply has inhibited functional recovery of the MCS. To address this challenge, we combined MCS transplantation with omentopexy (OP), which utilizes omental tissue as a surgical flap. Rats were divided into five groups: sham, myocardial infarction (MI), MCS transplantation, OP, and MCS + OP. Histologic analysis revealed that MCS + OP drastically reversed MI-induced cardiac remodeling. Echocardiography revealed that MCS increased cardiac function, while OP had a synergistic beneficial effect with MCS transplantation. Immunofluorescence imaging showed that OP increased the survival of transplanted cardiomyocytes, and increased the blood supply through enhancement of angiogenesis and migration of small arteries into the MCS. Taken together, we concluded that OP is a promising strategy for the enhancement of graft function in MCS transplantation.

肺癌術後２年目に発生した術側残存肺膿ようの１治験例

症例は66歳, 女性.右中葉原発の肺癌 (低分化型乳頭腺癌) に対し右上中葉切除術 (ND2a, pTIN0M0) が施行された.以後, 約3年の経過で残存下葉の一部 (S6) が徐々に破壊され, 非結核性抗酸菌症 (NTM), 更にアスペルギルスの感染を来し空洞化した.内科的治療の効果がなく, 全身状態の悪化を来たしはじめたため, 空洞の浄化を図るべく空洞切開を施行した.約6ヵ月間で空洞は浄化し, 栄養状態, 全身状態の改善を得られたため, 大網充填術を施行した.大網は腔内を充填するのに十分な量があり, 多数の瘻孔の閉鎖に有効であった.空洞切開創にあたる胸壁の欠損部は広背筋弁で補填した.術後経過は良好で, 呼吸機能の低下は軽度であり社会復帰した.

Long Survival after Omentopexy

Long Survival after Omentopexy

Case of Splenic Anæmia with Ascites, Treated by Splenectomy and Omentopexy

Case of Splenic Anæmia with Ascites, Treated by Splenectomy and Omentopexy

Omentopexy to the Intestine Deprived of Its Mesentery

Omentopexy to the Intestine Deprived of Its Mesentery