Evaluation of omental implantation for perforated gastric ulcer therapy: Findings in a rat model

Abstract

Omental implantation, a surgical procedure in which a perforated gastric or duodenal ulcer is repaired by drawing and implanting a portion of the omentum into the digestive tract, accelerates ulcer healing and inhibits ulcer recurrence. However, the mechanisms underlying these beneficial effects are largely unknown. To clarify these mechanisms, we investigated ulcer healing in two groups of rats in which acetic acid-induced gastric ulcers were perforated. Omental implantation was used for repair in one group and simple suturing was employed in the other group. Greater anti-inflammatory and angiogenic activity and accelerated collagen synthesis were seen in the omental implantation group. Basic fibroblast growth factor (bFGF)-mediated angiogenesis was noted in this group, as well as transforming growth factor-beta 1 (TGF-beta 1) activity within and around the omentum, resulting in abundant collagen production. It was confirmed that omental implantation accelerated ulcer healing and inhibited ulcer recurrence, and the presence of bFGF and TGF-beta 1 played a significant role in both these phenomena.

The serosal mesothelium is a major source of smooth muscle cells of the gut vasculature

“…Clinical relevance of the serosal mesothelium and its contribution to blood vessel formation Surgeons have long used the omentum, the serosal mesothelium and its connective tissue companion, to repair injured blood vessels and intestines with good success (Bertram et al, 1999;Matoba et al, 1996;Roa et al, 1999;Sterpetti et al, 1992). Although the cellular basis of this reparative function is unknown, it is interesting to speculate that serosal mesothelium may serve as a source of diverse cell types in injury repair.…”

An Overview of Acetic Acid Ulcer Models<br>&mdash;The History and State of the Art of Peptic Ulcer Research&mdash;

“…Matoba et al 140) evaluated the effects of omental implantation for perforated gastric ulcers using an acetic acid ulcer model in rats. Greater anti-inflammatory, angiogenic activity, and accelerated collagen synthesis were seen after omental implantation.…”

Diagnosis and treatment of perforated peptic ulcer by emergency laparoscopy in gynecology: a case report

“…Others suggest, as in open surgery, an omental patch technique that can be easily performed [13]. The omentum is easy to mobilize and has physiologic sealing properties by tissue adhesion and rich vascularization that hastens tissue healing [14]. Laparoscopic sutureless repair with a gelatin sponge plug and fibrin glue [12] or simple lavage relying on spontaneous sealing have been described to be as safe as the suture repair technique and also reduced operative time.…”