THE GREATER OMENTUM: Anatomy, Embryology, and Surgical Applications
Section snippets
DISCOVERY OF THE PROTECTIVE POWER OF THE GREATER OMENTUM
De Lamballe, a military surgeon during the wars of Napoleon I, was the first to draw attention to the greater omentum as an interesting structure that is useful for protection against infection. In 1829, he recorded his observation that, in preventing bowel injuries through adhesion formation, the greater omentum saved many wounded soldiers from peritonitis, a deadly disease in those days.15
The concept of using the omentum to rapidly form adhesions was spread in 1880 by the renowned
DISCOVERY OF THE USEFULNESS OF THE OMENTUM IN RECONSTRUCTIVE SURGERY
In 1926, aware of the versatility of the tissue, the surgeon Knazozovicky in Germany was the first to dare exteriorizing the undetached omentum through a tunnel to the body surface, that is, out of the abdominal cavity, to perform an arthroplasty.15 Thiessen (in 1935) and Walters (in 1937) of the Mayo Clinic introduced their technique of successful cure of intractable vesicovaginal fistulas by interposition of the omentum.15 Simultaneously, British heart surgeon O'Shaughnessy published in The
Description
The greater omentum is a free-hanging mesenteric tissue apron in the abdominal cavity (Fig. 1). Arising from the greater gastric curvature, it crosses the transverse colon, where it is attached and descends in front of the viscera down to the symphysis.15 The anterior surface faces the abdominal wall, that is, the parietal peritoneum; the posterior surface faces the visceral peritoneum. The origin of the omental edge varies among individuals. On the right side, it may hang from the pyloric
ORGANOGENESIS
The development of the omentum is closely related to adjacent structures, especially the stomach and spleen.13, 14, 15 This relationship provides the anatomic and biochemical background for the effectiveness of using the omentum in reconstructive and protective surgery and for experimental studies.
CLINICALLY RELEVANT NATURE OF THE OMENTUM
Recent studies have established that, under pathologic conditions, the omentum is endowed with distinct capacities, such as adhesion to traumatized tissue. The activated fibrinogen attaches the omentum immediately on rough, ischemic, and inflamed areas, especially after mechanical trauma to serosal surfaces.15 With regard to hemostasis, the omentum reduces profuse, uncontrollable hemorrhage by pressure. This has been ascribed to the omental ability of accelerating the activation of prothrombin
USE OF THE OMENTUM IN SURGERY
Because of its plasticity and great volume, the repair of defects using the omentum can be undertaken on the vascular pedicle within and outside of the abdominal cavity. The omentum can be used to repair defects in the abdomen and pelvic floor and tracheal and bronchial defects in the neck and on other surfaces of the body. Repair using the omentum begins with radical local clearance of the recipient side and ends with the substitution of the defect with omentum.
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The Omentum: Research and Clinical Applications
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Address reprint requests to Dorothea Liebermann-Meffert, Prof. Dr., MD, Nelkenweg 4, D79112 Freiburg, Germany
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Department of Surgery, Kantonsspital, University Hospital Basel, Basel, Switzerland