Abdominoperineal and anterior resection of the rectum with retrocolic omentoplasty and no drainage

Abstract

Forty consecutive patients scheduled for either low anterior resection or abdominoperineal resection of the rectum have been studied. After standard procedures, carried out by all grades of surgeons, the omentum was mobilized as a pedicle graft based on the left gastro-epiploic arcade and transposed to the pelvis or perineum. All wound were closed primarily without drainage. Twenty-six patients had anterior resection, 11 abdominoperineal resection and 3 an extended Hartmann's operation. Patients were assessed clinically and radiographically by Gastrografin enema and ultrasound for evidence of anastomotic leakage, pelvic collections and wound healing. After anterior resection there were three radiological leaks and no overt clinical leaks. One patient had a collection related to a leak. Of 11 perineal wound 8 healed primarily in 2 weeks and all healed by 4 weeks. There was no frank wound breakdown. The three patients who had Hartmann's operations all healed without complication. There were no unavoidable complications of the procedure. Retrocolic omentoplasty is a simple, safe and effective adjunct to rectal surgery. The additional time taken (15-20 min) is well rewarded by sound healing of these operations.

Omentoplasty in Abdominoperineal Resection: A Review of the Literature Using a Systematic Approach

“…13,15,23,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Seven publications were excluded because fewer than ten patients were included. 13,15,29,32,34,41,42 In addition, outcomes for patients in whom an omentoplasty was performed were not specified in two reports, and they were excluded.…”

“…37,40 Evaluation of control groups in the other two studies was difficult because reported parameters for comparison were few in one study, 39 and one study used historical controls. 36 In four publications, data were collected prospectively, 30,33,36,40 and six were retrospective studies. 23,28,[37][38][39]43 Patients reported in one publication 33 also may have been reported in another.…”

“…36 In four publications, data were collected prospectively, 30,33,36,40 and six were retrospective studies. 23,28,[37][38][39]43 Patients reported in one publication 33 also may have been reported in another. 36 The studies included are summarized in Table 2.…”

“…Seven authors advocated pedicled omentum based on the left gastroepiploic vessels. 23,30,33,36,37,40,43 Rice et al 38 used flaps based on the right gastroepiploic vessels, and in two reports the omentum was mobilized only using the epiploic arcade. 28,39 All authors except Hay et al, 40 who instead presented number of wounds healed at one month, reported rate of primary healing as an outcome measure.…”

Pelvic reconstruction after abdominoperineal resection: a pilot study using an absorbable synthetic prosthesis

“…An omental pedicle flap based on the left gastroepiploic vessels is left free or sutured into place in the pelvis. Alternatively, an omentopexy is performed using the omentum as a ''hammock,'' suturing the omental free edges to the sacral promontory, anterior abdominal wall and colon serosa [13][14][15][16][17][18][19][20][21][22][23][24][25]. Despite the extensive use of autologous tissues, especially the greater omentum, for creating a pelvic partition, there is no solid scientific evidence to support the use of one method over another.…”