Clinical study of omentoplasty in thoracic surgery

Abstract

We retrospectively reviewed our experience of omentoplasty, involving twenty-five patients treated with a pedicled omental flap for thoracic problems. Among them, 11 patients had empyema, 8 had postoperative bronchopleural fistula, 5 underwent bronchial covering for complicated bronchoplastic operation, and 1 had intractable sternal osteomyelitis after median sternotomy. All patients with empyema, bronchopleural fistula, and sternal osteomyelitis were controlled by one-stage omentoplasty. There was no postoperative leakage of bronchial anastomosis in the bronchial-covering cases. However, a patient with empyema and bronchopleural fistula showed relapse a long time after omentoplasty. There was one postoperative death due to respiratory failure and one case of stenosis of bronchial anastomosis following bronchial covering. No serious abdominal complication due to omentoplasty developed. In the operative procedure, conducting laparotomy first was significantly correlated with a shorter operatve time and smaller amount of blood loss than conducting thoracotomy first. One-stage omentoplasty for empyema or postoperative bronchopleural fistula is effective. On the other hand, covering for complicated bronchoplasty by a pedicled omental flap should be limited to high-risk cases with the possibility of impaired healing of bronchial anastomosis.