Omentectomy

Overview

An omentectomy is a surgical procedure in which part or all of the omentum is removed. The omentum is a layer of fatty tissue that drapes over the abdominal organs, such as the stomach and intestines. It contains fatty tissue and blood vessels that supply blood and provide physical protection to your organs. This procedure is often performed to stage or treat cancer, as tumors in the abdominal organs frequently spread to the omentum.

Types

There are two types of omentectomy:

• Partial omentectomy: Referred to as infracolic omentectomy, removes only a portion of the omentum.
• Total omentectomy: Known as supracolic omentectomy, involves the complete removal of the omentum.

Reasons for undergoing the procedure

Omentectomy is typically associated with cancer. While primary cancer originating in the omentum itself is rare, it frequently occurs that cancer spreads to the omentum from other areas within the abdomen. Types of cancers that may necessitate an omentectomy include:

• Stomach cancer.
• Colorectal cancer.
• Appendix cancer.
• Fallopian tube cancer.
• Ovarian cancer.
• Uterine cancer (endometrial).
• Prostate cancer.
• Peritoneal mesothelioma.
• Pseudomyxoma peritonei.

If cancer is detected in your omentum, surgical removal is generally recommended by your healthcare provider. Furthermore, your healthcare provider may recommend removing your omentum if you have nearby cancer likely to spread there. Sometimes, healthcare providers remove the omentum to check for microscopic signs of cancer. Finding evidence of cancer that has spread to the omentum helps them determine the cancer’s stage and decide on the appropriate treatment.

Risks

There are potential risks associated with all surgeries, including bleeding, infection, and damage to surrounding organs.

Specific risks following an omentectomy may include small bowel obstruction, where the bowels can become partially or completely blocked due to adhesions in the abdominal cavity.

Before the procedure

Omentectomy is usually part of a more extensive cancer surgery rather than being performed on its own. Before the surgery, you’ll have a consultation with your healthcare provider, who will explain the procedure in detail. They will review the risks and benefits of the surgery and assess your overall health to determine if you’re fit for the operation.

Abdominal surgeries necessitate enduring several hours under general anesthesia. To prepare, you will undergo various health screenings, such as blood tests and an EKG, to evaluate your heart function and overall health.

During the procedure

Omentectomy may be conducted using minimally invasive surgical techniques, such as laparoscopic or robotic surgery. This possibility depends on several factors, including your medical condition, the scope of the surgery, and the expertise and discretion of your surgeon.

Performing an omentectomy as a standalone procedure might seem relatively straightforward. When it involves removing cancer, it typically forms part of a more extensive operation. If you have cancer in multiple locations, surgeons typically aim to remove all affected areas in a single procedure.

Choosing a laparoscopic omentectomy means making fewer incisions and recovering more quickly. During the surgery, the healthcare provider makes three to four small incisions, each about half an inch wide. Long surgical equipment and a tiny camera known as a laparoscope are used in this treatment.

In an open abdominal procedure, your surgeon will access the abdominal cavity through a single, long incision across your abdomen. To excise as much cancer as possible, the surgery will involve removing your omentum and any other affected organs.

Omentectomy is often performed in combination with one or more additional surgical procedures, such as:

• Gastrectomy: Removal of part or all of the stomach.
• Colectomy: Removal of part or all of the colon.
• Cytoreductive or debulking surgery: Removal of cancer throughout the abdomen.
• Retroperitoneal lymph node dissection: Removal of one or several lymph nodes in the abdomen.
• Hysterectomy: Removal of the uterus.
• Salpingectomy: Removal of one or both fallopian tubes.
• Oophorectomy: Removal of one or both ovaries.
• Prostatectomy: Removal of the prostate gland.

If your cancer is in its early stages, your surgeon may conduct a “peritoneal wash” of your abdominal cavity. This involves rinsing the cavity with a sterile saltwater solution, extracting the solution, and sending it to the lab for analysis. This procedure helps determine if the cancer has spread.

After the procedure

After surgery, you can expect to recover in the hospital for several days. The duration may vary—shorter for laparoscopic procedures and longer if multiple organs are removed. Your surgeon will review the surgical outcomes and any significant lab results with you afterward.

You and your healthcare team will discuss your current health status and determine the next steps in your treatment plan. After cancer surgery, your healthcare provider may recommend additional treatments such as radiation therapy or chemotherapy to ensure all cancer cells are eliminated.

Outcome

An omentectomy can serve multiple purposes: preventive, exploratory, therapeutic, or curative. In the case of early-stage cancer, removing and examining the omentum can help prevent the cancer from spreading or provide essential information about its extent.

If the cancer is confined to the omentum, its surgical removal may offer a potential cure. For metastatic cancer that has spread to multiple sites, extensive removal can enhance treatment outcomes.

Recovery time varies depending on the complexity of the surgery. Minor procedures, such as laparoscopic surgeries, may require only a few weeks of recovery, while more extensive operations involving the removal of multiple organs might need up to eight weeks for full recovery.