Omentoplasty in thoracic surgery

Abstract

Plombage methods were designed for treating pulmonary tuberculosis surgically around 1945 when pulmonary tuberculosis was regarded as a "traitor disease" in Japan. Nagaishi had reported extrapleural synthetic resin ball plombage in 1948 as the world's first case, but it was complicated by empyema due to perforation of cavities and rupture of lesions because the resin ball was hard. Later, fillers were improved by using soft material. At the present time, only air plombage and omentoplasty remain. Especially the latter has gained widespread use in the thoracic surgery field and become a standard procedure. Chronic empyema with bronchopleural fistula sometime requires surgical treatment despite the development of various antibiotics, but highly stressful surgery that can cause reduced pulmonary function or thoracic deformity must be avoided. Therefore, one-stage omentoplasty utilizing such omental multi-functions as hose action, angiogenesis, sucker action, and the immune reaction has been found to have clinical significance for thoracic empyema and its complications. This method is described in detail.

Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy

“…This is because the omentum has anti-inflammatory properties and promotes tissue healing because of the presence of abundant blood vessels and lymphatics (19). Okumura reported that using omental pedicle flap for chronic empyema provided clinical success in 82.6% (19/23) without compromising pulmonary function.…”

Omental flap for treatment of dead space after left upper lobectomy due to aspergilloma

“…A long-term follow-up study examining chronic empyema patients treated with an omental flap also showed encouraging results, with the procedure producing no adverse effects on pulmonary function (4). Under normal circumstances, the omentum serves primarily as a protective tissue in the abdomen, though it has been shown to exhibit a variety of other functions, including cell transport, angiogenesis, absorption of bodily fluids, and immune regulation (5). In patients undergoing the omental flap, this diverse set of functions is thought to aid in the control of local infections, and promote healing in the surrounding tissues.…”

Contrast-enhanced endoscopic ultrasonography (CE-EUS) findings in adrenal metastasis from renal cell carcinoma

“…The advent of EUS using a convex array echoendoscope was a major breakthrough in visualizing such remote lesions, rendering them amenable to both imaging and sampling [10]. The limited band and low acoustic power of EUS renders contrast harmonic imaging impossible, but the development of novel US contrast agents [11] that can produce harmonic signals at low acoustic power [12] has recently removed this disadvantage [13]. Sonazoid ® is a second-generation US contrast agent that can differentiate intra-tumor flow signals with characteristics similar to those of transabdominal US [14].…”