A surgeon’s history of the omentum: From omens to patches to immunity

Bass, Gary Alan; Seamon, Mark J.; Schwab, C. William

doi:10.1097/ta.0000000000002945

Cited by 10 publications

(5 citation statements)

References 68 publications

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“…While abscess cavities benefit from intra-operatively placed or percutaneously placed drains, prophylactic peritoneal drains remain devoid of supporting evidence [37][38][39][40]. Pedicled omentum may buttress anastomoses or sites of visceral repair as a vascularized and active host defense barrier [41]. When instestinal or anastomotic viability is uncertain, an open abdomen approach with or without negative pressure wound therapy (NPWT) provides ready access and has been described with and without concomitant continuous peritoneal lavage-an element embraced by devoted adherents but also without clear evidence of benefit [42][43][44][45].…”

Section: Adjuncts To Source Controlmentioning

confidence: 99%

Tertiary peritonitis: considerations for complex team-based care

Bass

Dzierba

Taylor

et al. 2021

Eur J Trauma Emerg Surg

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Peritonitis, as a major consequence of hollow visceral perforation, anastomotic disruption, ischemic necrosis, or other injuries of the gastrointestinal tract, often drives acute care in the emergency department, operating room, and the ICU. Chronic critical illness (CCI) represents a devastating challenge in modern surgical critical care where successful interventions have fostered a growing cohort of patients with prolonged dependence on mechanical ventilation and other organ supportive therapies who would previously have succumbed much earlier in the acute phase of critical illness. An important subset of CCI patients are those who have survived an emergency abdominal operation, but who subsequently require prolonged open abdomen management complicated by persistent peritoneal space infection or colonization, fistula formation, and gastrointestinal (GI) tract dysfunction; these patients are described as having tertiary peritonitis (TP).The organ dysfunction cascade in TP terminates in death in between 30 and 64% of patients. This narrative review describes key—but not all—elements in a framework for the coordinate multiprofessional team-based management of a patient with tertiary peritonitis to mitigate this risk of death and promote recovery. Given the prolonged critical illness course of this unique patient population, early and recurrent Palliative Care Medicine consultation helps establish goals of care, support adjustment to changes in life circumstance, and enable patient and family centered care.

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Section: Adjuncts To Source Controlmentioning

confidence: 99%

Tertiary peritonitis: considerations for complex team-based care

Bass

Dzierba

Taylor

et al. 2021

Eur J Trauma Emerg Surg

Self Cite

View full text Add to dashboard Cite

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“…The omentum is a double-layered membrane composed of the peritoneum and fatty tissue that contains blood vessels, nerves, lymphatic vessels, and connective tissue. [ 1 ] The omentum is attached to the greater curvature of the stomach and transverse colon, covering the organs in the abdominal cavity and is shaped like a skirt. If infections, tumors, or other diseases occur in the abdominal cavity, the omentum can limit the spread of the disease through the formation of wraps and adhesions.…”

Section: Introductionmentioning

confidence: 99%

“…The omentum is a double-layered membrane composed of the peritoneum and fatty tissue that contains blood vessels, nerves, lymphatic vessels, and connective tissue [1] . The omentum is attached to the greater curvature of the stomach and transverse colon, covering the organs in the abdominal cavity and is shaped like a skirt.…”

Section: Introductionmentioning

confidence: 99%

Primary liposarcoma of the omentum

et al. 2022

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Rationale: Omental liposarcoma is extremely rare, and only a few reports have been published in the literature. Due to the rarity of the disease, establishing a clear diagnosis and formulating a treatment plan may be challenging for clinicians. Patient concerns: The patient was a 51-year-old woman who presented with a protruding mass and pain in the lower abdomen. Diagnosis: Magnetic resonance imaging revealed a tumor measuring 15 cm in diameter in the pelvis. Ovarian cancer was suspected based on pre-operative imaging findings. Interventions: An exploratory laparotomy was performed. Intra-operative analysis of the frozen section suggested a benign tumor. Outcomes: Postoperative histopathological analysis confirmed the diagnosis of omental liposarcoma. The patient recovered well after surgery. Lesson: This case report helps clinical oncologists to develop a comprehensive understanding of this disease and treat it accordingly.

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“…In recent years, a variety of studies have focused on the relationship between the improvement of pancreaticojejunostomy methods and the incidence of pancreatic fistula, but there is currently no consensus. Studies have shown that the greater omentum has manyroles, such as promoting anticorrosion, and anti-infection effects, immune responses, secretion, and absorption of ascites [ 14 – 16 ]. The greater omentum can also regulate blood circulation in the gastrointestinal tract and transmit vascular endothelial growth factors, thereby accelerating the formation of new vessels at the anastomosis[ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Application analysis of omental flap isolation and modified pancreaticojejunostomy in pancreaticoduodenectomy (175 cases)

et al. 2022

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Background To explore the application value of free omental wrapping and modified pancreaticojejunostomy in pancreaticoduodenectomy (PD). Methods The clinical data of 175 patients who underwent pancreaticoduodenectomy from January 2015 to December 2020 were retrospectively analysed. In total, 86 cases were divided into Group A (omental wrapping and modified pancreaticojejunostomy) and 89 cases were divided into Group B (control group). The incidences of postoperative pancreatic fistula and other complications were compared between the two groups, and univariate and multivariate logistic regression analyses were used to determine the potential risk factors for postoperative pancreatic fistula. Risk factors associated with postoperative overall survival were identified using Cox regression. Results The incidences of grade B/C pancreatic fistula, bile leakage, delayed bleeding, and reoperation in Group A were lower than those in Group B, and the differences were statistically significant (P < 0.05). Group A had an earlier drainage tube extubation time, earlier return to normal diet time and shorter postoperative hospital stay than the control group (P < 0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) inflammatory factors 1, 3 and 7 days after surgery also showed significant. Univariate and multivariate logistic regression analyses showed that a body mass index (BMI) ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap and modified pancreaticojejunostomy were independent risk factors for pancreatic fistula (P < 0.05). Cox regression analysis showed that age ≥ 65 years old, body mass index ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap isolation and modified pancreaticojejunostomy, and malignant postoperative pathology were independent risk factors associated with postoperative overall survival (P < 0.05). Conclusions Wrapping and isolating the modified pancreaticojejunostomy with free greater omentum can significantly reduce the incidence of postoperative pancreatic fistula and related complications, inhibit the development of inflammation, and favourably affect prognosis.

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A surgeon’s history of the omentum: From omens to patches to immunity

Cited by 10 publications

References 68 publications

Tertiary peritonitis: considerations for complex team-based care

Tertiary peritonitis: considerations for complex team-based care

Primary liposarcoma of the omentum

Application analysis of omental flap isolation and modified pancreaticojejunostomy in pancreaticoduodenectomy (175 cases)

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