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Omento(Fat)Plasty After Colorectal Anastomosis May Reduce Leakages
Luana Franceschilli, Nicola Di Lorenzo, Ilaria Capuano, Vinicio De Felice, Federica Giorgi, Achille Lucio Gaspari, Pierpaolo Sileri*
Surgery, University of Rome Tor Vergata, Rome, Italy
Anastomotic leak after colorectal surgery has a tremendous impact on mortality, morbidity and quality of life. It has been proposed that ‘omento(fat)plasty' around the anastomosis may reduce anastomotic leak incidence.
However data are scant and contradictory. In this study we assess the role of omentoplasty after colorectal anastomosis.
Patients and methods:
A total of 332 colorectal anastomosis performed between May 2004 to September 2014 were considered for this study. All data were prospectively collected and entered in a colorectal database. Inclusion criteria were: elective surgery for left colectomy or anterior resection (either open or laparoscopic), anastomosis >8 cm from the anal verge (either manual or mechanical), high ligation of inferior mesenteric vein, full splenic mobilisation, and absence of faecal diversion. Patients underwent or not ‘omentoplasty' after anastomosis. Primary endpoint was clinical anastomotic leak. Secondary endpoins included mordidity and mortality as well as longer-term anastomosis stricture.
Results:
One-hundred-eighty-one patients underwent ‘omentoplasty' while 151 received a standard anastomosis. Both groups were similar for demographics, indications and type of surgery (including manual/mechanical anastomosis, terminal/lateral anastomosis). Overall a total of 12 clinical anastomotic leaks were observed, 3 in the ‘omentoplasty' group and 9 in the no-‘omentoplasty' group (1.7% vs 5.9%, p=0.05). All patient but one required reintervention. Overall mortality was 1.2%, with a similar risk between the two groups.
Conclusion:
‘Omentoplasty' in our experience seems to protect from anastomosis leak.
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