The Omentum - The Surgeon's Friend
Dr. Dan Brehm

The omentum has been described in the literature as both “abdominal
policeman” and “the forgotten organ.” It is a unique and versatile organ
that can be utilized for a variety of surgical procedures. Given this, the
omentum can also be described as “the surgeon’s friend.”

The omentum is rich in lymphatics and is a source of blood vessels and
fibroblasts. It is thin, so it provides very little structural support, but
it can be utilized to cover other organs and to obliterate space. The
omentum is atached to the stomach and is composed of two leaves. The blood
supply is derived primarily from the stomach vessels. Because of this
arrangement, the omentum can be extended in length. The blood supply to one
leaf is ligated, and this leaf is freed from its attachment and folded
caudally to increase the total length of the omentum. Also, a flap can be
created from this extended omentum to further increase its total length.
These modifications increase the total length of the omentum to the point
where it can reach any point in the cat and nearly any point in the dog.
This allows the omentum to be utilized in a large number of surgeries
involving all or nearly all of the animal’s body.

The most common use of the omentum is as an adjunct to intestinal surgery.
The omentum is either wrapped around or sutured to the intestine at an
anastomosis or enterotomy site. The omentum fills in small gaps between
sutures in the intestine, and provides another source of blood vessels and
inflammatory cells for healing. The omentum should not be considered,
though, as a replacement for good suturing technique nor will it bring about
viability in a nonviable segment of intestine. The omentum has also been
used similarly in thoracic esophageal surgery when an aide to healing is
desired (the omentum is brought through a small hole that is created in the
diaphragm and placed or sutured around the esophageal surgery site).

The omentum can also be used to assist healing in other sites. Chronic,
non-healing skin wounds can be assisted by omentalization. The omentum is
harvested from the abdomen and, in most cases, lengthening techniques are
used to create a flap that will reach the wound site. The omentum is
tunneled under the skin to the wound site, and sutured into place. The
supplemental healing properties that the omentum provides has been shown to
dramatically enhance wound healing. Many chronic wounds that have had
multiple surgeries and/or a prolonged period of local wound care without
success have gone on to heal dramatically after omentalization.

Finally, the omentum can be used as a physiological drain. The rich
lymphatic and blood vascular supply within the omentum can assist in the
absorption of fluids in a number of body locations. This method can be used
to eliminate the need for drains that exit the skin to drain to the outside
of the body. Two relatively recently described techniques that utilize the
omentum as a physiological drain are treatments for prostatic abscesses and for
prostatic or paraprostatic cysts. The previously described treatment methods
for prostatic abscesses were to place one or multiple Penrose drains into the
abscess cavity and to exit them through the skin lateral to the prepuce.
This location made bandaging difficult or impossible, so there was frequently
extensive drainage that was inconvenient for the dog and owners; also,
ascending infections were a potential concern. With omentalization, the
prostatic abscess cavities are digitally broken down to create one cavity.
The omentum is extended if needed, passed through the hole in the prostatic
wall (that was made when the single cavity was created), and then out through
the second hole, or it is passed around the prostatic urethra and exited out
through the first hole. The omentum is sutured in place. The body wall is
closed routinely, with no drains emerging through the skin. This technique
effectively treated prostatic abscesses most of the time and was associated
both with lower complication and lower recurrence rates. Prostatic cysts are
treated similarly, with similarly good results.

The omentum is an extremely useful organ with a variety of potential
uses. Clearly, it was placed in the abdomen for a reason. The best rule of
thumb, then, is to go ahead and utilize it when you can.

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