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Bikkumalla S, Chandak SR, Zade AA, Reddy S, Ram Sohan P, Hatewar A. Omentoplasty in Surgical Interventions: A Comprehensive Review of Techniques and Outcomes. Cureus 2024; 16:e66227. [PMID: 39238731 PMCID: PMC11374580 DOI: 10.7759/cureus.66227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 08/05/2024] [Indexed: 09/07/2024] Open
Abstract
Omentoplasty, a surgical technique utilizing the omentum's unique properties, has become a pivotal intervention across various surgical fields. This comprehensive review explores the historical evolution, techniques, applications, outcomes, and complications associated with omentoplasty. With its rich vascular supply, lymphatic tissue, and remarkable immunological properties, the omentum has proven invaluable in enhancing wound healing, controlling infections, and providing mechanical support in complex surgical scenarios. The review delves into the anatomy and physiology of the omentum, elucidating its role in promoting angiogenesis and combating infections. Different omentoplasty techniques, including open, laparoscopic, and robotic-assisted approaches, are compared with regard to indications, procedural steps, and outcomes. The applications of omentoplasty span general surgery, cardiothoracic surgery, neurosurgery, gynecologic surgery, and urologic surgery, highlighting its versatility and broad clinical relevance. Short-term and long-term outcomes of omentoplasty, including postoperative recovery, complication rates, recurrence rates, and quality of life, are thoroughly analyzed. The review addresses common and rare complications, emphasizing prevention and management strategies to optimize patient outcomes. Innovations in surgical techniques, the use of biomaterials, and the potential for synthetic or bioengineered omentum are discussed, underscoring the future directions and research opportunities in this field. By providing a detailed examination of omentoplasty, this review aims to enhance understanding, guide clinical practice, and inspire future research to further improve surgical outcomes and patient care.
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Affiliation(s)
- Shruthi Bikkumalla
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suresh R Chandak
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anup A Zade
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Srinivasa Reddy
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Poosarla Ram Sohan
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akansha Hatewar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Peng Y, Xiong S, Ding Y, Xie L, Wang Y, Mei Y, Liu W, Deng T. The effect of omentoplasty in various surgical operations: systematic review and meta-analysis. Int J Surg 2024; 110:3778-3794. [PMID: 38446845 PMCID: PMC11175753 DOI: 10.1097/js9.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Omentoplasty is commonly used in various surgeries. However, its effectiveness is unsure due to lack of convincing data and research. To clarify the impact of omentoplasty on postoperative complications of various procedures, this systematic review and meta-analysis was performed. METHODS A systematic review of published literatures from four databases: PubMed, Web of Science, Cochrane Library, and Embase before 14 July 2022. The authors primarily included publications on five major surgical operations performed in conjunction with omentoplasty: thoracic surgery, esophageal surgery, gastrointestinal surgery, pelvi-perineal surgery, and liver surgery. The protocol was registered in PROSPERO. RESULTS This review included 25 273 patients from 91 studies ( n =9670 underwent omentoplasty). Omentoplasty was associated with a lower risk of overall complications particularly in gastrointestinal [relative risk (RR) 0.53; 95% CI: 0.39-0.72] and liver surgery (RR 0.54; 95% CI: 0.39-0.74). Omentoplasty reduced the risk of postoperative infection in thoracic (RR 0.38; 95% CI: 0.18-0.78) and liver surgery (RR 0.39; 95% CI: 0.29-0.52). In patients undergoing esophageal (RR 0.89; 95% CI: 0.80-0.99) and gastrointestinal (RR 0.28; 95% CI: 0.23-0.34) surgery with a BMI greater than 25, omentoplasty is significantly associated with a reduced risk of overall complications compared to patients with normal BMI. No significant differences were found in pelvi-perineal surgery, except infection in patients whose BMI ranged from 25 kg/m 2 to 29.9 kg/m 2 (RR 1.25; 95% CI: 1.04-1.50) and anastomotic leakage in patients aged over 60 (RR 0.59; 95% CI: 0.39-0.91). CONCLUSION Omentoplasty can effectively prevent postoperative infection. It is associated with a lower incidence of multiple postoperative complications in gastrointestinal and liver surgery.
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Affiliation(s)
- Yaqi Peng
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Shan Xiong
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Yujin Ding
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Limin Xie
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Yihang Wang
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Ying Mei
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
| | - Wei Liu
- Department of Biliopancreatic Surgery and Bariatric Surgery
| | - Tuo Deng
- National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology
- Key Laboratory of Diabetes Immunology, Ministry of Education, Metabolic Syndrome Research Center
- Clinical Immunology Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
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Pellegrin A, Pasinato G, Regimbeau JM, Sabbagh C. Purse string closure of perineal defects after abdominoperineal excision. Langenbecks Arch Surg 2023; 408:309. [PMID: 37580449 DOI: 10.1007/s00423-023-03044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE The aim of this study was to describe a new technique of perineal closure following abdominoperineal excision (APE) using purse-string perineal skin closure (PSPC). MATERIAL AND METHODS Between January 2016 and May 2021, 15 consecutives patients who had an APE procedure were included in this retrospective single-center study. All indications of APE were considered, as well as all types of APE. We analyzed the patient characteristics and peri-operative features, including overall (Clavien 1 to 5) and severe (Clavien 3 and 4) postoperative morbidity, length of stay (LOS), and long-term results (median time to perineal wound closure and rate of perineal incisional hernia). RESULTS The patients included 11 men and four women, with a mean age of 64 ± 13 [33-80] years. The indication of APE was an epidermoid carcinoma of the anal canal (n = 5) or an adenocarcinoma of the rectum (n = 10). The mean operating time was 220 ± 88.64 [70-360] min. The overall morbidity rate was 60%, the severe morbidity rate 26%, and reoperation rate 26%. The median length of stay was 9 ± 6.5 days. After a mean follow-up of 23.5 ± 20.3 months, the median time to perineal wound closure was 96 ± 60 days, the persistent perineal sinus rate was 6% (n = 2), and one patient developed a perineal incisional hernia. CONCLUSION Purse-string closure of perineal wounds is a safe and effective technique for perineal wound closure after APE. The short LOS allowed an early return home.
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Affiliation(s)
- Alexandra Pellegrin
- Department of Digestive Surgery, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens, France
| | - Gaétan Pasinato
- Department of Digestive Surgery, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens, France
- UR UPJV 7518, SSPC (Simplification of Surgical Patients Care), University of Picardie Jules Verne, Amiens, France
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens, France.
- UR UPJV 7518, SSPC (Simplification of Surgical Patients Care), University of Picardie Jules Verne, Amiens, France.
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Mori GA, Tiernan JP. Management of Perineal Wounds Following Pelvic Surgery. Clin Colon Rectal Surg 2022; 35:212-220. [PMID: 35966381 PMCID: PMC9374536 DOI: 10.1055/s-0042-1742414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Despite advancements in understanding and technique, there remain significant challenges in the management of a complex perineal wound following pelvic surgery. Complications including wound sepsis, fistulation, persistent sinus, and herniation produce additional morbidity and health care costs. This article details the methods of optimizing patient and operative factors to mitigate this risk, alongside strategies to deal with sequelae of wound failure.
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Affiliation(s)
- George A Mori
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, United Kingdom
| | - Jim P Tiernan
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, United Kingdom
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Sharabiany S, Kreisel SI, Strijk GJ, Blok RD, Bosschieter J, Laan ETM, Cunningham C, Hompes R, Musters GD, Tanis PJ. Exploring the impact of urogenital organ displacement after abdominoperineal resection on urinary and sexual function. Int J Colorectal Dis 2022; 37:2125-2136. [PMID: 36044045 PMCID: PMC9562368 DOI: 10.1007/s00384-022-04234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to establish the functional impact of displacement of urogenital organs after abdominoperineal resection (APR) using validated questionnaires. METHODS Patients who underwent APR for primary or recurrent rectal cancer (2001-2018) with evaluable pre- and postoperative radiological imaging and completed urinary (UDI-6, IIQ-7) and sexual questionnaires (male, IIEF; female, FSFI, FSDS-R) were included from 16 centers. Absolute displacement of the internal urethral orifice, posterior bladder wall, distal end of the prostatic urethra, and cervix were correlated to urogenital function by calculating Spearman's Rho (ρ). Median function scores were compared between minimal or substantial displacement using median split. RESULTS There were 89 male and 36 female patients included, of whom 45 and 19 were sexually active after surgery. Absolute displacement of the internal urethral orifice and posterior bladder wall was not correlated with UDI-6 in men (ρ = 0.119 and ρ = 0.022) nor in women (ρ = - 0.098 and ρ = - 0.154). In men with minimal and substantial displacement of the internal urethral orifice, median UDI-6 scores were 10 (IQR 0-22) and 17 (IQR 5-21), respectively, with corresponding scores of 25 (IQR 10-46) and 21 (IQR 16-36) in women. Displacement of the cervix and FSDS-R were correlated (ρ = 0.433) in sexually active patients. CONCLUSION This first analysis on functional impact of urogenital organ displacement after APR suggests that more displacement of the cervix might be associated with worse sexual function, while the data does not indicate any potential functional impact of bladder displacement. Studies are needed to further explore this underexposed topic.
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Affiliation(s)
- Sarah Sharabiany
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia I. Kreisel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gaby J. Strijk
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Robin D. Blok
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Judith Bosschieter
- Department of Urology, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Ellen T. M. Laan
- Department of Sexology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Christopher Cunningham
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Roel Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gijsbert D. Musters
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter J. Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Doctor Molewaterplein 30, 3015 GD Rotterdam, the Netherlands
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Sharabiany S, Strijk GJ, Blok RD, Ferrett CG, Stoker J, Cunningham C, van der Bilt JDW, van Geloven AAW, Bemelman WA, Hompes R, Musters GD, Tanis PJ. Quantifying displacement of urogenital organs after abdominoperineal resection for rectal cancer. Colorectal Dis 2021; 23:2923-2931. [PMID: 34427972 PMCID: PMC9291959 DOI: 10.1111/codi.15885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to quantify displacement of urogenital organs after abdominoperineal resection (APR), and to explore patient and treatment characteristics associated with displacement. METHOD Patients from 16 centres who underwent APR for primary or recurrent rectal cancer (2001-2018) with evaluable preoperative and 6-18 months postoperative radiological imaging were included in the study. Anatomical landmarks on sagittal images were related to a coordinate system based on reference lines between fixed bony structures and absolute displacements were calculated using the Pythagorean theorem. Rotation of landmarks was measured relative to a pubic-S5 reference line. RESULTS There were 248 patients included of which 171 were men and 77 women. The median displacement of the internal urethral orifice was 25 mm in men (maximum 65), and 17 mm in women (maximum 50). Rotation of the internal urethral orifice was in a caudal direction in 160/170 (94%) of men and 65/73 (89%) of women, with a median of 32 degrees (maximum 85) and 33 degrees (maximum 83), respectively. Displacements of the posterior bladder wall, distal end of prostatic urethra and cervix were significantly correlated with the internal urethral orifice. In linear regression analysis, biological mesh reconstruction of the pelvic floor and visceral interposition were significantly associated with increased displacement of the internal urethral orifice, and female gender and any filling of the presacral space with decreased displacement. CONCLUSIONS Substantial absolute displacement and rotation of urogenital organs after APR for rectal cancer were observed, but with high variability among both men and women, and being significantly associated with reconstructive interventions.
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Affiliation(s)
- Sarah Sharabiany
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Gaby J. Strijk
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Robin D. Blok
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Colin G. Ferrett
- Department of RadiologyOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Jaap Stoker
- Department of RadiologyAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Christopher Cunningham
- Department of Colorectal SurgeryChurchill HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | | | | | - Wilhelmus A. Bemelman
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Roel Hompes
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Gijsbert D. Musters
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pieter J. Tanis
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
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Sharabiany S, van Dam JJW, Sparenberg S, Blok RD, Singh B, Chaudhri S, Runau F, van Geloven AAW, van de Ven AWH, Lapid O, Hompes R, Tanis PJ, Musters GD. A comparative multicentre study evaluating gluteal turnover flap for wound closure after abdominoperineal resection for rectal cancer. Tech Coloproctol 2021; 25:1123-1132. [PMID: 34263363 PMCID: PMC8419133 DOI: 10.1007/s10151-021-02496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
Background The aim of this study was to compare perineal wound healing between gluteal turnover flap and primary closure in patients undergoing abdominoperineal resection (APR) for rectal cancer. Methods Patients who underwent APR for primary or recurrent rectal cancer with gluteal turnover flap in two university hospitals (2016–2021) were compared to a multicentre cohort of primary closure (2000–2017). The primary endpoint was uncomplicated perineal wound healing within 30 days. Secondary endpoints were long-term wound healing, related re-interventions, and perineal herniation. The perineal hernia rate was assessed using Kaplan Meier analysis. Results Twenty–five patients had a gluteal turnover flap and 194 had primary closure. The uncomplicated perineal wound-healing rate within 30 days was 68% (17/25) after gluteal turnover flap versus 64% (124/194) after primary closure, OR 2.246; 95% CI 0.734–6.876; p = 0.156 in multivariable analysis. No major wound complications requiring surgical re-intervention occurred after flap closure. Eighteen patients with gluteal turnover flap completed 12-month follow-up, and none of them had chronic perineal sinus, compared to 6% (11/173) after primary closure (p = 0.604). The symptomatic 18-month perineal hernia rate after flap closure was 0%, compared to 9% after primary closure (p = 0.184). Conclusions The uncomplicated perineal wound-healing rate after the gluteal turnover flap and primary closure after APR is similar, and no chronic perineal sinus or perineal hernia occurred after flap closure. Future studies have to confirm potential benefits of the gluteal turnover flap.
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Affiliation(s)
- S Sharabiany
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J J W van Dam
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - S Sparenberg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R D Blok
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - B Singh
- Department of Surgery, Leicester University Hospital, Leicester, UK
| | - S Chaudhri
- Department of Surgery, Leicester University Hospital, Leicester, UK
| | - F Runau
- Department of Surgery, Leicester University Hospital, Leicester, UK
| | | | | | - O Lapid
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - G D Musters
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands.
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