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Omentoplasty Periprocedural Care

  • Author: Ashwin Pai, MBBS; Chief Editor: Kurt E Roberts, MD  more...
 
Updated: Aug 11, 2014
 

Equipment

The standard laparotomy set is required for omentoplasty; it includes the following:

  • Scalpel with No. 11 and No. 15 blades
  • Curved and straight artery forceps
  • A pair of toothed thumb forceps
  • A pair of nontoothed forceps
  • Allis forceps
  • Noncrushing intestinal clamps
  • Surgical cautery
  • Hemostatic clips or ligatures
  • Handheld ultrasonic dissector (if available)
  • Abdominal wall retractors or self-retaining retractors
  • Atraumatic visceral retractors
  • Suture materials (absorbable and nonabsorbable)
  • Anastomotic staplers
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Patient Preparation

Infection (followed by graft extrusion) are the most common complications. Prevention requires thorough preoperative preparation, administration of antibiotics prophylaxis before the procedure, and strict maintenance of intraoperative sterility.

General anesthesia is preferred for this procedure. An epidural block may be added for postoperative pain management. After anesthesia induction, a 16-F or 18-F Ryle tube is passed and kept on continuous drainage. The patient is then catheterized with a 14-F Foley catheter so that intraoperative and postoperative urine output can be monitored.

The patient is placed in a supine position, and preparation should include the whole of the abdomen, as well as the affected limb in which the omental transplant is planned.

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Monitoring and Follow-Up

Patients are assessed 7 days, 1 month, and 3 months after undergoing omentoplasty. The success of the procedure is evaluated both subjectively and objectively. The primary subjective criterion is symptomatic improvement. The main objective criteria include the following:

  • Improvement in the local skin temperature
  • Healing of ulcers and the amputation site
  • Improved oxygen saturation values on pulse oximetry
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Contributor Information and Disclosures
Author

Ashwin Pai, MBBS MS (GenSurg), MRCS, Honorary Assistant Medical Officer, Department of Surgery, Kasturba Medical College, India

Disclosure: Nothing to disclose.

Chief Editor

Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

References
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  3. Sasajima T, Kubo Y, Izumi Y, Inaba M, Goh K. Plantar or dorsalis pedis artery bypass in Buerger's disease. Ann Vasc Surg. 1994 May. 8(3):248-57. [Medline].

  4. Stricht VJ, Goldstein M, Flamand JP, Belenger J. Evolution nad prognosis of thromboangitis obliterans. J Cardiovasc surg (Torino). 1973. 14:9-16.

  5. Kunlin J, Lengua F, Testart J, Pajot A. Thromboangiosis or thromboangeitis treated by adrenalectomy and sympathectomy from 1942 to 1962. A follow-up study of 110 cases. J Cardiovasc Surg (Torino). 1973 Jan-Feb. 14(1):21-7. [Medline].

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  8. Goldsmith HS, Griffith AL, Catsimpoolas N. Increased vascular perfusion after administration of an omental lipid fraction. Surg Gynecol Obstet. 1986 Jun. 162(6):579-83. [Medline].

  9. Goldsmith HS, Griffith AL, Kupferman A, Catsimpoolas N. Lipid angiogenic factor from omentum. JAMA. 1984 Oct 19. 252(15):2034-6. [Medline].

  10. Bronzetti G, Galli A, Della Croce C. Antimutagenic effects of chlorophyllin. Basic Life Sci. 1990. 52:463-8. [Medline].

  11. Agarwal VK, Bajaj S. Salvage of end stage extremity by omentopexy in Buerger’s disease. Indian Journal of Thoracic and cardiovascular surgery. 1987. 5:12-17.

  12. Subodh S, Mohan JC, Malik VK. Omentopexy in limb revascularisation in Buerger's disease. Indian Heart J. 1994 Nov-Dec. 46(6):355-7. [Medline].

  13. Borham MM. Comparison between omentoplasty and partial cystectomy and drainage (PCD) techenques in surgical management of hydatid cysts liver in endemic area (Yemen). J Egypt Soc Parasitol. 2014 Apr. 44(1):145-50. [Medline].

  14. Killeen S, Mannion M, Devaney A, Winter DC. Omentoplasty to assist perineal defect closure following laparoscopic abdominoperineal resection. Colorectal Dis. 2013 Oct. 15(10):e623-6. [Medline].

  15. Boiskin I, Karna A, Demos TC, Blakeman B. Herniation of the transverse colon: an unusual complication of pedicled omentoplasty. Can Assoc Radiol J. 1995 Jun. 46(3):223-5. [Medline].

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Omentoplasty. Omentum being mobilized.
Omentoplasty. Omentum being mobilized to reach below knee.
Omentoplasty. Skin incisions made on limb for subcutaneous tunneling of omentum.
 
 
 
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