Laparoscopic Harvesting of Omental Flaps for Breast Reconstruction—A Review of the Literature and Outcome Analysis

Shash, Hani; Al-Halabi, Becher; Aldekhayel, Salah; Dionisopoulos, Tassos

doi:10.1177/2292550317731762

Cited by 16 publications

(16 citation statements)

References 34 publications

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“…4 Our second concern is that body mass index (BMI) greater than 35 kg/m 2 is considered a contraindication factor for omental flap because of safety concerns expressed by some authors. 5 However, the author did not mention the data regarding the celiac artery problems and BMI in the present study. We would like to emphasize that preexisting celiac artery problems and higher BMI scores could mask the outcomes, because these parameters can affect the omental flap coverage therapy.…”

mentioning

confidence: 75%

Role of Celiac Trunk and Patient Body Mass Index on Omental Flap for Management of Thoracic Aortic Graft Infection

Hernández

Stranix

Kovach

2020

The Annals of Thoracic Surgery

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mentioning

confidence: 75%

Role of Celiac Trunk and Patient Body Mass Index on Omental Flap for Management of Thoracic Aortic Graft Infection

Hernández

Stranix

Kovach

2020

The Annals of Thoracic Surgery

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“…More importantly, several episodes of excessive coughing after the surgery is a risk of dehiscence in the abdominal wound, especially after the traditional approach, which should be repaired immediately, but the laparoscopic approach minimizes it. 33 Various complications such as mesenteric hematoma, 7,10,11 conversion to laparotomy, 10,11,31 cardiovascular problems, 31 pedicle injury, 5,7,34 and hernia in donor site 5,7,34 have been reported as a result of the harvesting of free intestinal flaps laparoscopically.…”

Section: Discussionmentioning

confidence: 99%

“…First, vascular pedicle injuries are more common with the laparoscopic approach than with the traditional approach. 5,7,34 It is probably related to its deeper location and as it is more demanding to dissect around the highly rich vascular arcade and intestinal tissues. Second, there is a possible risk of damage to the serosa layer of intestine by electrocautery, which may create intraabdominal adhesions in the future.…”

Section: Discussionmentioning

confidence: 99%

“…4 Recently, laparoscopic harvesting of omental flaps for lymphedema treatment or breast reconstruction and endoscopic-assisted harvesting of serratus anterior, latissimus dorsi, gracilis, and rectus femoris muscles with limited donor site morbidities, when only muscle tissue is required for extremity reconstruction, have been described in the literature. [5][6][7][8] Unlike these studies, very few clinical studies that involve harvesting jejunal flaps laparoscopically have been described in humans. [9][10][11] At our institution, intestinal flaps are the first choice for esophageal reconstruction because of their spontaneous peristalsis ability, mucus production, and luminal shape.…”

mentioning

confidence: 99%

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Risks of Laparoscopic Harvest of Free Intestinal Flaps for Esophageal Reconstruction

Aksoyler

Losco

Sert

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Performing ablative surgery using an laparoscope is a common practice. However, its use in the harvest of a segment of intestine for reconstruction has 2 major challenges: risk of damage to the vascular pedicle of the flap as well as to the vessels of other parts of the intestine that remain in the peritoneal cavity and risk of damage to the intestinal flap while pulling it out through a small opening in the abdominal wall. The aim of this study was to report advantages and disadvantages of harvesting free intestinal flaps using the laparoscopic method, explaining the challenges faced and lessons learned from this experience.Patients and Methods: Free intestinal flaps were harvested by laparoscopy in 12 patients aged 28 to 63 years. There were 9 free jejunal flaps for the reconstruction of the cervical esophagus and 3 ileocolic flaps for the reconstruction of both the cervical esophagus and voice reconstruction.Results: In 1 patient, laparoscopy was converted to laparotomy due to previous colectomy, which resulted in compromised circulation to the rest of the colon. One jejunal flap had leakage at its pharyngeal end; therefore, a pectoralis major myocutaneous flap was used for closure. In addition, 1 ileocolic flap had partial loss of its anterior wall, and a free anterolateral flap was used as a patch for closure. Furthermore, it was very difficult to harvest 1 free jejunal flap due to the thick and fat mesentery. Conclusion:Prolonged operative times, unexpected leakage at the anastomosis sites, partial loss of flaps, possible risk of vascular pedicle damage or venous compromise, demanding pedicle dissection in obese patients, and requirement of conversion to laparotomy are the major drawbacks of harvesting free intestinal flaps by laparoscopy.

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“…A recent study by Zaha (14), the largest reported series on oncoplastic surgery with an LHPOF, showed the promising oncological safety and clinical benefits of this procedure. The free omental flap used for breast reconstruction in this procedure has been proven to be reliable and safe (1,15), and LHPOF has been shown to cause the least amount of donor site deformity (5,10,13,14,16,17). However, in previous studies, either open surgery was used for mastectomy or the omental flap was taken from another incision in the abdominal wall, resulting in obvious scars on the chest and abdominal wall and less than ideal aesthetic results.…”

Section: Introductionmentioning

confidence: 99%

Breast reconstruction using a laparoscopically harvested pedicled omental flap after endoscopic mastectomy for patients with breast cancer: an observational study of a minimally invasive method

Wang¹,

Pei²,

Qiu³

et al. 2020

Gland Surg

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Background: Breast reconstruction is typically performed using autologous tissue from a laparoscopically harvested omental flap. Because open surgery and another abdominal wall incision for a subcutaneous tunnel cannot be avoided, minimal scars typically cannot be achieved. This study explored a minimally invasive method of pedicled omental flap breast reconstruction in which omentum harvesting, mastectomy, and subcutaneous tunnel establishing were performed laparoscopically and endoscopically, and large incisions on the thoracic and abdominal wall were unnecessary.Methods: Ten patients with breast cancer were enrolled. They underwent endoscopic subcutaneous mastectomy (ESM) and single-stage breast reconstruction using a laparoscopically harvested pedicled omental flap (LHPOF), which was pulled through a subcutaneous tunnel that was created under laparoscopic vision. The incisions made on the abdominal wall were no wider than 12 mm, and the thoracic wall incisions were no wider than 30 mm. Three of the patients had a prosthetic implant placed for reconstruction at the same time because of the large breast volume, and the omental flaps were used to cover the prostheses.Results: All patients underwent successful single-stage breast reconstruction surgery, and laparotomy was not required. Eight of the patients (80%) had satisfactory aesthetic results (five had excellent results and three had good results). The incisions at the thoracic wall and in the donor site area were short and hidden. The mean operation time was 367.6 min and the mean time for harvesting the omental flap was 62.9 min, similar to previous studies. The total mean blood loss was 37.0 mL. No serious donor-site complications occurred.Conclusions: LHPOF breast reconstruction combined with ESM is minimally invasive, and satisfactory aesthetic results are achievable. In patients who undergo ESM combined with prosthetic implant reconstruction, the pedicled omental flap can be used to cover the prosthesis instead of using acellular dermal matrix.

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Laparoscopic Harvesting of Omental Flaps for Breast Reconstruction—A Review of the Literature and Outcome Analysis

Abstract: Omentum use is safe and has advantages in breast reconstruction where other options are limited including a natural feeling and minimal donor site morbidity if harvested laparoscopically.

Cited by 16 publications

References 34 publications

Role of Celiac Trunk and Patient Body Mass Index on Omental Flap for Management of Thoracic Aortic Graft Infection

Role of Celiac Trunk and Patient Body Mass Index on Omental Flap for Management of Thoracic Aortic Graft Infection

Risks of Laparoscopic Harvest of Free Intestinal Flaps for Esophageal Reconstruction

Breast reconstruction using a laparoscopically harvested pedicled omental flap after endoscopic mastectomy for patients with breast cancer: an observational study of a minimally invasive method

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