Ten-year experience with laparoscopic pedicled omental flap for cerebral revascularization in patients with Moyamoya disease

Salimi-Jazi, Fereshteh; Wood, L. D. H.; Jones, Ruth Ellen; Chandler, Julia M.; Rafeeqi, Talha; Dutta, Sanjeev; Bruzoni, Matías

doi:10.1016/j.jpedsurg.2022.01.023

Cited by 5 publications

(3 citation statements)

References 17 publications

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“…At present, pedicled omental ap, as a source of biomaterials, has been widely used in the prevention or treatment of complications, such as rectovaginal stula and vesicovaginal stula, cerebrovascular reconstruction, tissue damage repair, and as a carrier to promote regeneration, etc. [49][50][51][52] , which has solved many clinical treatment problems. The pedicled omentum was free and transplanted to the pelvic oor to simulate the reconstruction of the mesentery around the neorectum and the presacral tissue, which avoided the intestinal stiffness caused by the adhesion between the neo-rectum and the presacral tissue, reduced the pressure of the neo-rectum, improved the compliance of the neo-rectum, and increased the defecation buffer.…”

Section: Discussionmentioning

confidence: 99%

Mesorectal reconstruction with pedicled greater omental transplantation to relieve low anterior resection syndrome following total intersphincteric resection in patients with ultra-low rectal cancer

Liao

Qin

Wang

et al. 2022

Preprint

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BACKGROUND AND OBJECTIVES: Total intersphincteric resection (ISR) is the ultimate anus-preserving surgery for patients with ultra-low rectal cancer (ULRC), which can result in various degrees of anorectal dysfunction. Known as low anterior resection syndrome (LARS), it seriously affects the postoperative quality of life of patients. The aim of this study was to discuss the value of mesorectal reconstruction with pedicled greater omental transplantation (PGOT) to relieve LARS following total ISR in patients with ULRC, hoping to provide new ideas and strategies for the prevention and improvement of LARS. METHODS We retrospectively analyzed hospitalization data and postoperative anorectal function of 26 ULRC patients, who were met inclusion and exclusion criteria in our center from January 2015 to February 2022. And combined with the results of anorectal manometry and rectal magnetic resonance imaging (MRI) defecography of some patients, we assessed comprehensively anorectal physiological and morphological changes of the patients after surgery, and their correlation with LARS. RESULTS In this study, 26 patients with ULRC were enrolled and divided into observation group (n = 15) and control group (n = 11) according to whether pedicled omental transplantation was performed. There were no significant differences in surgical results such as operative time, intraoperative blood loss and postoperative complications between the two groups (P > 0.05). Postoperative follow-up showed that patients in both groups showed severe LARS within 3 months after surgery, but from the 3rd month after surgery, LARS in both groups gradually began to decrease, especially in the observation group, which showed faster recovery and better recovery, with statistically significant differences (P < 0.001). Through anorectal manometry, the mean rectal resting pressure in the observation group was significantly lower than that in the control group (P = 0.010). In addition, the postoperative thickness of the posterior rectal mesenterium in the observation group was significantly higher than that in the control group (P = 0.001), and also higher than the preoperative level (P = 0.018). Moreover, rectal MRI defecography showed that the new rectum had good compliance under the matting of greater omentum, and its intestinal peristalsis was coordinated. CONCLUSION ULRC patients, with the help of greater omentum, coordinated their neo-rectum peristalsis after total ISR and recovery of LARS was faster and better. PGOT is expected to be an effective strategy for LARS prevention and treatment of ULRC patients after surgery and is worthy of clinical promotion.

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Section: Discussionmentioning

confidence: 99%

Mesorectal reconstruction with pedicled greater omental transplantation to relieve low anterior resection syndrome following total intersphincteric resection in patients with ultra-low rectal cancer

Liao

Qin

Wang

et al. 2022

Preprint

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“…Another study showed that in 30 pediatric patients undergoing greater omental transposition surgery, the neurological function of almost all patients improved after surgery, and the recovery rate of patients was correlated with the number of newly formed collateral circulation vessels [75]. A series of subsequent studies suggested that ischemic symptoms could be effectively reduced in almost all patients treated by omental transposition [51,[76][77][78]. This is attributed to the function of the omentum by providing additional sources of blood vessels and synthesizing VEGF to promote the formation of new blood vessels and increase cerebral perfusion (Table 1).…”

Section: Moyamoya Diseasementioning

confidence: 99%

The Greater Omentum: Multifaceted Interactions in Neurological Recovery and Disease Progression

2024

Aging dis

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The greater omentum, a unique anatomical structure composed of adipocytes, loose connective tissue, and a dense vascular network. Plays a pivotal role beyond its traditional understanding. It houses specialized immunological units known as 'Milky spots,' making it a key player in immune response. Moreover, the omentum's capacity to enhance tissue perfusion, absorb edema fluid, boost acetylcholine synthesis, and foster neuron repair have rendered it a topic of interest in the context of various diseases, especially neurological disorders. This review provides a comprehensive overview of the intricate anatomy and histology of the greater omentum, casting light on its multifaceted functions and its associations with a spectrum of diseases. With a specific focus on neurological ailments, we delineate the intricate relationship that the omentum shares with other pathologies like stroke and we underly its contribution to serving as a therapeutic agent in neurological disorders. By deciphering the underlying mechanisms and emphasizing areas that demand further investigation. This review aims to spark renewed interest and pave the way for comprehensive studies exploring the greater omentum's potential in neurology and broader medicine overall. Given these diverse interactions that yet remain elusive, we must investigate and understand the nuanced relationship between the greater omentum and pathologies, especially its role in stroke's pathophysiology and therapeutic interventions so as to enhance patient care.

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“…When the superficial temporal artery is hypoplastic or unavailable, a previous bypass failed, or the ischemic territory is in the anterior cerebral artery or posterior cerebral artery territory where bypasses are more technically challenging, rescue therapies such as multiple burr holes 95 and omental flaps 96,97 have been conducted. However, data on the efficacy of such procedures in adults are limited.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Adult Moyamoya Disease and Syndrome: Current Perspectives and Future Directions: A Scientific Statement From the American Heart Association/American Stroke Association

Gonzalez,

Amin-Hanjani,

Bang

et al. 2023

Stroke

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Adult moyamoya disease and syndrome are rare disorders with significant morbidity and mortality. A writing group of experts was selected to conduct a literature search, summarize the current knowledge on the topic, and provide a road map for future investigation. The document presents an update in the definitions of moyamoya disease and syndrome, modern methods for diagnosis, and updated information on pathophysiology, epidemiology, and both medical and surgical treatment. Despite recent advancements, there are still many unresolved questions about moyamoya disease and syndrome, including lack of unified diagnostic criteria, reliable biomarkers, better understanding of the underlying pathophysiology, and stronger evidence for treatment guidelines. To advance progress in this area, it is crucial to acknowledge the limitations and weaknesses of current studies and explore new approaches, which are outlined in this scientific statement for future research strategies.

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Ten-year experience with laparoscopic pedicled omental flap for cerebral revascularization in patients with Moyamoya disease

Cited by 5 publications

References 17 publications

Mesorectal reconstruction with pedicled greater omental transplantation to relieve low anterior resection syndrome following total intersphincteric resection in patients with ultra-low rectal cancer

Mesorectal reconstruction with pedicled greater omental transplantation to relieve low anterior resection syndrome following total intersphincteric resection in patients with ultra-low rectal cancer

The Greater Omentum: Multifaceted Interactions in Neurological Recovery and Disease Progression

Adult Moyamoya Disease and Syndrome: Current Perspectives and Future Directions: A Scientific Statement From the American Heart Association/American Stroke Association

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