Omentectomy: indications, procedure, consequences

What is the definition of an omentectomy?

Omentectomy is surgical removal of the omentum. “In anatomy, the omentum is like a cover in the abdomen. It’s hooked in the stomach and colon transverse from the upper abdomen, and lies freely over the colon and small intestine to the small pelvis. The omentum is a membrane composed of fats and small vessels, explains Professor Jean-Marc Classe, visceral surgeon at the Nantes Cancer Institute, Professor of Cancerology and former head of the oncological surgery department. In practice, omentectomy is performed in closed surgery, by laparoscopy, or open, by laparotomy (abdominal incision).

Indications: when to do an omentectomy?

The omentum is an area that it is possible to biopsy, and its removal is not performed in the context of benign pathologies. For example, in the early ovarian cancer, it is the organ chosen to be analyzed in order to know the stage of the disease: we speak of staging intervention. Omentectomy is one of the stages of treatment of advanced cancer in order to remove the tumors lying on it. “In case of digestive cancer or ovarian cancer for example, the cells make small cancerous nodules, which will be deposited everywhere in the abdomen, in particular on the omentum, which is often the seat. If the cancer is at an early stage, we can remove the omentum to find out if the omentum is affected. When the disease is at a very advanced stage, omentectomy takes place to remove all the nodules present on the omentum“, says the surgeon. Indeed, since the omentum is in contact with other tissues and several surrounding visceral organs, tumors can spread and worsen the patient’s state of health. For example, in the case of a cancer of digestive origin, in particular colorectal cancer, one can see appearing in the evolution of the disease of the nodules on the peritoneum, the small intestine or the omentum. These are nodules of peritoneal carcinomatosis.

Omentectomy is performed in two different ways: by laparoscopy or by laparotomy.

► By laparoscopythe surgeon performs 4 incisions (small openings) in the abdomen in order to pass a camera and its instruments, to intervene on the omentum. “The omentum is very soft and its removal is a surgical act that is one of the simplest gestures taught to interns. The omentum, once detached, is placed in a sterile bag which unfolds when it is dropped into the abdomen. This bag prevents the omentum from coming into contact with the skin. Then, we take out the bag through one of the incisions“.

“Once the omentum is removed, the patient can live normally”

► The second technique of removal of the omentum is laparotomy. And according to Professor Jean-Marc Classe, “this surgery is even easier to perform for a surgeon familiar with visceral surgery. When the omentectomy is part of a more complete, multivisceral surgery, then we realize a median opening, which goes from the sternum to the pubis“. The scar is therefore vertical, and more visible than by laparoscopy.

What are the side effects of an omentectomy?

Omentectomy usually does not present no postoperative complications, because the intervention is often without difficulty, except in the event of lesion on a surrounding organ. On the other hand, its anatomy means that the omentum touches the spleen, and in some cases, removal of the spleen must also take place if it is the seat of nodules.

What are the post-operative consequences of an omentectomy?

Laparoscopic omentectomy is performed under general anesthesia and requires hospitalization for 2 to 3 days. This is a staging operation, the hospitalization is quite short. The surgery can even take place on an outpatient basis. On the other hand, hospitalization is longer in case of surgery by laparotomy : it lasts on average 7 to 10 days. If another organ had to be removed (such as the spleen, rectum), if the patient is tired, then recovery may also take longer. “Once the omentum is removed, the patient can live normally. We do not know its exact role, but we know that there is no major risk of living without an epiploon”, says Professor Jean-Marc Classe. In the event of a staging intervention, omentectomy makes it possible to know the stage of the cancer, the objective being to set up a precise treatment, as quickly as possible. At an advanced stage, omentectomy takes place to remove cancerous nodules to halt the progression of cancer at the visceral level. It is a complete surgery, which increases the patient’s chances of recovery.

Thanks to Professor Jean-Marc Classe, visceral surgeon at the Nantes Cancer Institute, Professor of Cancerology and former Head of the Oncology Surgery Department.