Giant peptic ulcer perforation- omentopexy versus omental plugging: a comparative study

Background: Giant peptic ulcer perforation is a life-threatening surgical emergency with high mortality rate. This study compares two different surgical techniques omentopexy and omental plugging for the treatment of giant peptic perforation.Methods: This study was a prospective study comparing the efficacy of omental plugging and omentopexy. The study was done at Emergency Department of General Surgery in Nalanda Medical College and Hospital, Patna over one-year period from October 2017 to September 2018. Patients were randomly allocated to two groups: one for omental plugging (cases) and other for omentopexy (controls).Results: A prospective non-randomized study of 12 patients with giant peptic perforation (≥2 cm in diameter) was carried out over a period of 24 months. The highest incidence was seen in males over 50 years of age. Biliary leak rates were 33% in the omentopexy group compared to no leak in the omental plugging group. This rate when calculated on standard error of proportion was significant at 5% level (p<0.05). Mortality rate was higher in omentopexy group compared to omental plugging group.Conclusions: Omental plugging seems to be associated with low rates of biliary leak compared to omentopexy and hence should be the procedure of choice in giant peptic ulcer perforation compared to omentopexy.

A Stitch in Time Saves Nine - A Novel Treatment of Duodenal Perforation Closure

Introduction: There are many techniques for closure ofperforation and there is continuing debate in the literatureregarding the preferred surgical procedure for the patientwith a perforated peptic ulcer. Our objective is to comparethe efficacy and safety of figure of eight suturing techniquecoupled with pedicled omental graft repair versus conventionalomentopexy. In this study we proposed to either prove orreject the null-hypothesisMaterial and methods: The proposed study was conductedin Department of Surgery JJM medical college and BapujiHospital, Davangere. 50 patients included in the study weredivided into two groups after randomization; the groupsbeing patients undergoing figure of eight suturing coupledwith pedicled omental graft repair technique for pepticulcer perforation (SG) and patients undergoing conventionalomentopexy technique for peptic ulcer perforation (CG).Results: Majority of patients in this study were of group 15-30 years and 88% were males. Majority of cases had 2cmperforation (36 cases 72%) and most of the perforations werein first part of duodenum (58%). Complications were seenin 72% of patients, most common being wound infection(40%) and 4 patients in control group had bile leak (8%). Oralfeeding was started earlier in the study group as compared tocontrol group. The intra-operative time taken in study groupwas lesser than control group. The hospital stay was lesser instudy group.Conclusion: In conclusion, the present study is superior thanstandard omentopexy in terms of intra-operative time taken,bile leak, duration of hospital stay, commencement of oral feedand mortality. It can be used as a safe alternative to standardomentopexy. As with figure of eight suturing technique, lessertendency to cut through because the pressure at one point isdivided into two directions, and the pressure is exerted on fourpoints instead of two points

Laparoscopic Single Figure of Eight Suturing Omentopexy for the Treatment of a Perforated Duodenal Ulcer

PURPOSE: Safe and effective surgical treatment of peptic ulcer perforations is fundamental to achieve favorable outcomes. We present laparoscopic single figure of eight suturing omentopexy for perforated duodenal ulcer and review associated clinical outcomes. This is a new formulaic surgical technique for laparoscopic omentopexy. METHODS: Laparoscopic single figure of eight suturing omentopexies for perforated duodenal ulcer were completed in 15 consecutive patients between April 2008 and November 2017 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Using prospectively collected data, we performed an observational study on an intention-to-treat basis. RESULTS: The mean age of the 15 patients who underwent laparoscopic repair was 41.7±13.9 years. The perforation site was the anterior duodenal bulb in all patients. The median perforation size was 5 mm (range: 3~8 mm). The mean operation time was 66.7±19.6 minutes. There was no evidence of leakage from the omentopexy site clinically or in the postoperative upper gastrointestinal series. One patient (6.7%) experienced the postoperative complication of pneumothorax. There were no cases of postoperative mortality or reoperation within 30 days after surgery. The median time to tolerance of regular diet was 6 (range: 4~9) days. The median postoperative hospital stay was 7 days (range: 5~11 days). CONCLUSION: Laparoscopic single figure of eight suturing omentopexy can be a viable option in the surgical management of perforated duodenal ulcer in selected patients without surgical risk factors. Laparoscopic single figure of eight suturing omentopexy is safe and easy to perform, and may therefore reduce operation time.

Giant peptic ulcer perforation: Omentopexy versus omental plugging – A study

Giant peptic ulcer perforation is a life threatening surgical emergency with high mortality rate. This study compares two different surgical techniques Omentopexy and Omental plugging for the treatment of giant peptic perforation. A prospective non-randomized study of 36 patients with giant peptic perforation (>=2 cm in diameter) was carried out over a period of 24 months .The highest incidence was seen in males over 50 years of age. Biliary leak rates were 22.22% in the omentopexy group compared to no leak in the omental plugging group. This rate when calculated on standard error of proportion was significant at 5% level (p<0.05).Mortality rate was higher in omentopexy group compared to omental plugging group.

Infected Abdominal Aortic Aneurysm with a Previous History of Coronary Artery Bypass Grafting with the Right Gastroepiploic Artery / 日本心臓血管外科学会雑誌

We report a case of successful anatomical reconstruction with omentopexy of an infected abdominal aortic aneurysm (AAA) in a patient with a previous history of coronary artery bypass grafting with the right gastroepiploic artery. A 60-year-old man was referred to our institute because of fever and abdominal pain during hemodialysis for chronic renal failure. Antibiotic therapy was started after computed tomography revealed an infected abdominal aortic aneurysm. After infection control, surgical treatment was scheduled. At surgery, left axillo-bifemoral bypass was performed first, because it was unclear whether the omentum was large enough for omentopexy. At laparotomy, adequate omentum and infective AAA were confirmed. AAA repair using a rifampicin-soaked graft, and omentopexy were performed. <i>Enterobacter aerogenes </i>was detected from the resected aortic wall. After the operation, intravenous antibiotic was used for 25 days until CRP was normalized. One year follow-up showed no sign of re-infection.

Successful Treatment of Prosthetic Graft Infection 7 Years after Ascending Aorta Replacement and Aortic Root Replacement with a Freestyle Stentless Valve / 日本心臓血管外科学会雑誌

A 62 year-old man presented with severe septic shock complicated by prosthetic graft infection, 7 years after aortic root replacement with a Freestyle stentless valve and graft replacement of the ascending aorta. We initially managed the patient with antimicrobial therapy for 2 months and subsequently surgery was performed, replacing the infected aortic graft with rifampicin-bonded prostheses, and added omentopexy. The infection was cured and has not recurred.

Effect of Omentopexy Combining Autologous Atrial Tissue Patch Cardiomyoplasty for Treating the Chronic Myocardial Infarction in Experimental Rats / 中国循环杂志

Objective: To explore the effect of omentopexy combining autologous atrial tissue patch cardiomyoplasty for treating the chronic myocardial infarction (MI) in experimental rats. Methods:The MI model of SD rats was established by left coronary artery ligation. 3 weeks later, the qualiifed animals were randomized into 4 groups for the 2nd operation. ① Control group, the rats only received re-thoracotomy, ② Atrial appendage group, the autologous atrial tissue patch was harvested from left atrial appendage of rats and transplanted to infarcted zone, ③ Omentum group, the omentum of rats was transplanted to infarcted zone through diaphragm and ④ Combination group, the left atrial appendage tissue and omentum were transplanted to infarcted zone together. 4 weeks after the 2nd operation, the cardiac function was evaluated by echocardiography, the size and scar thickness of the infarction were examined by Masson staining, the survival of transplanted atrial tissue and angiogenesis were measured by immunohistochemistry, the protein expressions of VEGF, MMPs and TIMP-3 were examined by Western blot analysis, and the activities of MMPs were identiifed by gelatin zymography. Results:4 week after the 2nd operation, transplanted left atrial appendage tissue only survived in Combination group. The areas of infarction were similar among different groups, P>0.05. Compared with Control group, Combination group had the increased scar thickness (329 ± 33)μm vs (391±31)μm, improved LVEF (47.5 ± 4.5)%vs (57.9 ± 5.8)%, improved LVFS (20.7 ± 2.0)%vs (25.2 ± 3.6)%, all P Conclusion:Omentopexy could improve the angiogenesis and support the survival of transplanted autologous atrial tissue patch, therefore improve the cardiac function in experimental rats with chronic MI.

Omentopexy Decreasing the Susceptibility of Ventricular Arrhythmia in Experimental Rats With Chronic Myocardial Infarction / 中国循环杂志

Objective: To conifrm the omentopexy decreasing the susceptibility of ventricular arrhythmia in experimental rats with chronic myocardial infarction (MI) by nerve remodeling. Methods: The MI model of SD rats was established by left coronary artery ligation. 3 weeks later, the qualiifed animals were randomized into 3 groups for the 2nd operation. ① Sham operation group, the rats received the 2nd operation without ligation, ② Isolated MI group, the rats received the 2nd operation without omentopexy, ③ Omentopexy group, the rats received the 2nd operation with omentopexy. n=20 in each group. 4 weeks after the 2nd operation, the electrophysiological characteristics were assessed by relevant techniques, the new and sympathetic nerves in MI border zone were examined by immunohistochemistry, the protein expressions of connexin43 and nerve growth factor (NGF) were measured by western blot analysis and the cardiac endothelin-1 (ET-1) level was evaluated by ELISA. Results: Compared with Isolated MI group, Omentopexy group showed decreased susceptibility of arrhythmia (3.5 ± 1.2) vs (0.9 ± 0.2), improved electrical transduction (1.5 ± 0.2) mV vs (3.4 ± 0.3) mV and decreased capture threshold (5.5 ± 0.3) mV vs (2.2 ± 0.2) mV, all P Conclusion: Omentopexy may decrease the susceptibility of ventricular arrhythmia after MI in experimental rats, which might be related to the cardiac nerve remodeling.

Fatores de risco, achados clínicos, laboratoriais e avaliação terapêutica em 36 bovinos com deslocamento de abomaso / Risk factors, clinical and laboratorial findings and therapeutic evaluation in 36 cattle with abomasal displacement

A contínua seleção genética para maior produção de leite em conjunto com o aumento da capacidade digestiva e profundidade corporal aumentou a susceptibilidade à ocorrência de abomasopatias, incluindo o deslocamento do abomaso. Este trabalho objetivou realizar um estudo retrospectivo sobre o deslocamento de abomaso em 36 bovinos atendidos na Clínica de Bovinos, Campus Garanhuns da Universidade Federal Rural de Pernambuco, durante o período de janeiro de 2000 a fevereiro de 2009. Foram diagnosticados 27 casos de deslocamento do abomaso à direita, seis casos de deslocamento do abomaso à esquerda e três casos de vólvulo abomasal. Onze casos considerados moderados, sem grave distensão abdominal, apetite presente para a forragem e delimitação de som metálico até o 8º espaço intercostal, foram tratados clinicamente; enquanto 20 casos com distensão abdominal moderada a severa, associada a distúrbios sistêmicos, foram considerados graves e tratados cirurgicamente. Duas vacas foram eutanasiadas devido peritonite difusa ou alterações graves na serosa do abomaso, totalizando 18 animais submetidos ao tratamento cirúrgico. Dois animais foram encaminhados para abate e três vacas chegaram prostradas e morreram sem receber nenhum tratamento. A análise dos fatores de risco identificou a estação chuvosa como estatisticamente significativa. O maior número de deslocamento do abomaso ocorreu em vacas mestiças com 24 casos (66,6 por cento), seguida por bovinos da raça Holandesa com 11 (30,5 por cento) e Gir com um (2,9 por cento) caso. A composição da alimentação oferecida variou bastante e caracterizou-se por conter excesso de carboidratos e, na maioria dos casos, fibra de baixa qualidade. Os sinais clínicos mais frequentes foram comportamento apático, desidratação, timpanismo ruminal leve a severo com motilidade ausente ou diminuída, som de líquido ao balotamento do flanco direito, som de chapinhar metálico e/ou observação de uma estrutura similar a uma víscera...

The continuous genetic selection for high milk production in association with greater digestive capacity and corporal depth increases the susceptibility for abomasopathies including abomasal displacement. The present work aimed to accomplish a retrospective study on abomasal displacement in 36 cattle attended at Bovine Clinic, Garanhuns Campus, Federal Rural University of Pernambuco, through January 2000 to February 2009. Twenty seven cases of right abomasal displacement, six cases of left abomasal displacement and three of abomasal volvulus were diagnosed. Eleven moderate cases, without severe abdominal distention, appetite for roughage and metallic sound (ôpingõ) reaching at the most the 8th intercostal space were treated conservatively, and 20 severe cases with moderate to severe abdominal distention associated to systemic disturbances were treated surgically. Two cows were euthanized due to diffuse peritonitis or severe alterations in the abomasal serosa totalizing 18 animals submitted to the surgical treatment. Two animals were slaughtered and three cows arrived prostrated and died without receiving any treatment. Risk factor analysis identified rainy season as statistically significant. The greater number of abomasal displacement was in crossbred cows with 24 cases (66.6 percent), followed by Holstein and Gir cattle with 11 (30.5 percent) and one (2.9 percent) cases, respectively. Food composition varied greatly and characterized by excess of carbohydrates and in most cases low quality fibers. Most frequent clinical signs were apathy, dehydration, light to severe ruminal bloat with reduced or absent motility, splashing sound during right flank ballottement, ping and a distended viscera-like structure in the side of the displacement; liquid, blackish and fetid feces. Hematology reveals leukocytosis with neutrophilia and hyperfibrinogenemia in most cases. Ruminal fluid analysis showed compromised flora and fauna dynamics and increased...

Abdominopelvic Omentopexy to Prevent Postoperative Radiotherapy Complications in Rectal Cancer after Abdominoperineal Resection

PURPOSE: In rectal cancer, it is known that the postoperative radiotherapy is an effective way for reducing locoregional recurrence, especially if accompanied with concurrent chemotherapy. However, toxicity to small bowel was one of the major limitations to perform full-dose radiotherapy. For overcoming this problem, abdominopelvic omentopexy, which separates the small bowel from the pelvic cavity, was developed. This study analyses the acute and chronic complications related to the partitioning of the pelvic cavity and subsequent postoperative radiotheraphy. METHODS: From January 1990 to September 1999, medical records of 127 patients with rectal cancer who underwent abdominoperineal resection were retrospectively reviewed. Seventy-one of these patients belonged to stages B2 through D according to the modified Astler-Coller classification and underwent adjuvent chemoradiation therapy, and abdominopelvic omentopexy was performed in thirty- three patients. We compared postoperative radiotherapy complications between abdominopelvic omentopexy group and non-abdominopelvic omentopexy group. After abdominoperineal resection, the greater omentum covers whole small bowel like apron. The lateral edges are attached to both lateral peritoneal wall with continous running suture. The lower margin is sutured to the parietal peritoneum of the posterior abdominal wall at the level of the aortic bifurcation. The pelvic reperitonealization was carried out in whole patients. RESULTS: In the group of radiotheraphy with abdominopelvic omentopexy, six patients showed signs of acute radiation enteritis, whereas no case of chronic radiation- induced enteropathy was observed. Other complications were postoperative ileus (three patients), urinary problems (four patients), radiation dermatitis (ten patients), and radiation-induced leukopenia (three patients). In the group of radiotheraphy without abdominopelvic omentopexy, 7 out of 38 patient developed symptom and sign of radiation- induced chronic complication. The chronic complication rate is significantly lower in the omentopexy group than in the non-omentopexy group (P=0.0089). CONCLUSIONS: Abdominopelvic omentopexy is effective for preventing the late sequela of radiation-induced enteritis.

The role of omentopexy in tracheal transplantation in dogs

The major step toward successful tracheal transplantation is revascularization of the grafted trachea. There are many reports that although omentopexy is an effective method to facilitate neo-vascularization in tracheal transplantations, the procedure has not been accepted universally in the transplantation field. It remains unclear whether an omentopexy can successfully revascularize tracheal graft regardless of the length of graft. This study was undertaken to assess the usefulness of omentopexy for long-segment(more than 4 cm) tracheal allotransplantation. We have performed six tracheal transplantations with omentopexy (group A) and four tracheal transplantations without omentopexy (group B) in mongrel dogs from July 1993 to February 1995. Five mid-portion tracheal rings were removed from ten donor dogs and ten corresponding tracheal rings were removed from the ten recipient dogs. The excised tracheal rings from the donors were transplanted to the recipient tracheal-excised sites. All the recipients were given cyclosporine, azathioprine, and prednisolone for immunosuppression in the post-operative period. The histologic results of all the surviving members of group B were better than those of the group A. These findings indicate that omentopexy has a limitation, it is not a major method for graft revascularization. Therefore the length of the tracheal graft was greater than 4.0 cm, for its viability, a longer tracheal graft requires some other blood supply aside from the omentopexy.