Laparoscopic Creation of an Omental Flap

A. The Condition. You may have a large wound or tissue defect which will be closed or filled with your omentum. The omentum is a large drape-like structure of tissue inside your abdomen. It can be quite mobile, which makes it useful for filling tissue defects in surgery. When tissue is mobilized for this purpose, it is called a “flap.”

B. Symptoms. Your problem which requires an omental flap can be one of many, so the symptoms that you may have can be quite varied.

C. Laparoscopic Creation of an Omental Flap. The surgeon will make about 3-4 small incisions in your abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to create the omental flap. This type of surgery often is done with another surgeon present, such as a plastic surgeon or a chest surgeon, who will handle the final positioning of the omental flap to treat your specific problem. After the omental flap has been placed, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

Dr. Frantzides was the first in the world to report a Laparoscopic Omental – Cerebellar Pedicled Graft in 2002.

D. Nonsurgical Treatment. There is really no other treatment other than surgery for this problem.

E. Risks. The primary risks of laparoscopic creation of an omental flap are:

• Infection of the skin at one of the small ports sites
• Postoperative ileus (the intestines slow down/stop working for several days)
• Injury to the intestine

F. Expectations

1. Before Your Operation. Laparoscopic creation of an omental flap usually is an elective procedure. The preoperative evaluation might include blood work, urinalysis, and possibly a CT scan. If you smoke, then you should stop immediately. If you are taking blood thinners (for example, aspirin, coumadin, Lovenox, or Plavix), then you will need to stop these one week prior to your procedure. Your surgeon and anesthesia provider will review your health history, medications (including blood thinners), and options for pain control.

2. Your Recovery. You usually can go home in 1 or 2 days after a laparoscopic creation of an omental flap. You may need to wait until your bowels begin to work again. You will be given medication for pain. You should limit your activity to light lifting (no more than 15 lb) for one month.

3. Call Your Surgeon if you have one or more of the following:

• Severe pain
• High fever
• Odor or increased drainage from your incision
• No bowel movements for three days

Pertinent Reference

Frantzides C.T., Madan AK, Ferguson RL, Kumari NVA; Laparoscopic omentalcerebellar pedicled graft harvest; Surg. Laparosc. Endosc. & Percutaneous 12:383-386,2002.