How to perform a laparoscopic omentoplasty in pelvic surgery?

The omentum has the potential to obliterate the pelvic defects created during urological, gynecologic or digestive surgeries. The omentoplasty has been proposed as a means for reducing the perineal complication rate frequently associated. In this case, we present the technique of a laparoscopic omentoplasty in a patient with a terminal colostomy. This video is recommended for digestive surgeons.

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How to perform a laparoscopic omentoplasty in pelvic surgery?

Authors

J Leroy, J Marescaux

Abstract

The omentum has the potential to obliterate the pelvic defects created during urological, gynecologic or digestive surgeries. The omentoplasty has been proposed as a means for reducing the perineal complication rate frequently associated. In this case, we present the technique of a laparoscopic omentoplasty in a patient with a terminal colostomy.
This video is recommended for digestive surgeons.

Classification

tips and tricks

Keywords

Laparoscopy, omentoplasty, pelvic surgery

Media type

Surgical video

Duration

03'20''

Publication

2008-11

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E-publication

WeBSurg.com, Nov 2008;8(11).
URL: http://www.websurg.com/doi-vd01en2470.htm

How to perform a laparoscopic omentoplasty in pelvic surgery?

1. Purpose and technique 00'15''

The purpose of this video is to describe a technique for a laparoscopic omentoplasty useful to cover a pelvic suture or a pelvic defect. The schematic shows the different steps to perform an omentoplasty dividing the right omental vessels and preserving the left omental vessels in order to avoid necrosis.

2. Freeing of attachments 00'34''

The attachments of the transverse colon are taken down from right to left. These attachments are divided from the hepatic flexure with the objective of preserving the vascular branches of the right omental artery. Freeing of the attachments between the greater omentum and the transverse colon may be carried out either with the use of monopolar cautery or with the Ligasure device as in the present case.

3. Dissection of gastric attachments 01'02''

Attachments of the omentum to the stomach are divided preserving the gastric vessels and the left omental vessels.

4. Greater omentum 01'39''

A first attempt is made in order to demonstrate tension being exerted when taking down the attachments. In this patient presenting with a terminal colostomy in the left iliac fossa, we retract the greater omentum caudally and laterally to the colostomy site. This caudal retraction is achieved easily. There is no tension in the pelvis and the omental vascularization is well preserved.

5. Omentum pelvic fixation 02'32''

In order to ensure its positioning and fill in the pelvic space, in this patient, we decide to fix the omentum in the pelvis using 2 separate stitches of 2/0 absorbable suture material. Biological glue may also be applied as other authors suggest. This omentoplasty technique is only achievable in the event of a voluminous omentum, which will allow to fill in the space and/or cover a pelvic digestive, vaginal and/or urological suture.