Abstract
Introduction
The omentum is acknowledged to have diverse functions in the pathophysiology of intra-abdominal disease. Its angiogenic properties act as a natural defense mechanism in peritonitis and intra-abdominal sepsis. With advancing technology the omentum is revealing itself as a new player in the field of molecular surgery with special reference to cancer, obesity and tissue reconstruction.
Materials and methods
This article reviews the existing and potential surgical applications of the omentum.
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References
Morison R. Remarks on some functions of the omentum. BMJ 1906;1:76–78.
Aristotle. On the parts of animals. Book IV 350 BC
Taranu T, Taranu T, Varlam H, et al. The arterial system of the greater omentum. Rev Med Chir Soc Med Nat 1998;102:139–142.
Ryan GB, Grobety J, Majno G. Postoperative peritoneal adhesions. A study of the mechanisms. Am J Pathol 1971;65:117–148.
Wilkosz S, Ireland G, Khwaja N, Walker M, Butt R, de Giorgio-Miller A, Herrick SE. A comparative study of the structure of human and murine greater omentum. Anat Embryol (Berl) 2005;209:251–261. doi:10.1007/s00429-004-0446-6.
Ranvier L. Recherches sur la formation des milles du grand epiplon. Arch Physiol 1880;1:421–428.
Van Vugt E, Van Rijthoven EA, Kamperdijk EW, Beelen RH. Omental milky spots in the local immune response in the peritoneal cavity of rats. Anat Rec 1996;244:235–245. doi:10.1002/(SICI)1097-0185(199602)244:2<235::AID-AR11>3.0.CO;2-Q.
Liebermann-Meffert D, White H, editors. The greater Omentum: Anatomy, Physiology, Pathology, Surgery, with an Historical Survey. New York, Springer, 1983, pp1–369.
Cui L, Johkura K, Liang Y, Teng R, Ogiwara N, Okouchi Y, et al. Biodefense function of omental milky spots through cell adhesion molecules and leukocyte proliferation. Cell Tissue Res 2002;310:321–330. doi:10.1007/s00441-002-0636-6.
Krist LF, Eestermans IL, Steenbergen JJ, Hoefsmit EC, Cuesta MA, Meyer S, et al. Cellular composition of milky spots in the human greater omentum: an immunochemical and ultrastructural study. Anat Rec 1995;241:163–174. doi:10.1002/ar.1092410204.
Krist LF, Koenen H, Calame W, van der Harten JJ, van der Linden JC, Eestermans IL, et al. Ontogeny of milky spots in the human greater omentum: an immunochemical study. Anat Rec 1997;249:399–404. doi:10.1002/(SICI)1097-0185(199711)249:3<399::AID-AR11>3.0.CO;2-J.
Wijffels JF, Hendrickx RJ, Seetenbergen JJ, Eestermans IL, Beelen RH, et al. Milky spots in the omentum may play an important role in the origin of peritoneal macrophages. Res Immunol 1992;143:401–409. doi:10.1016/S0923-2494(05)80072-0.
Beelen RHJ, Fluitsma DM, Hoefsmit EC. Peroxidatic activity of mononuclear phagocytes developing in omentum milky spots. J Reticuloendothel Soc 1980b;28:601–609.
Mandache E, Moldoveanu E, Savi G. The involvement of omentum and its milky spots in the dynamics of peritoneal macrophages. Morphol Embryol (Bucur) 1985;31:137–142.
Zhu H, Naito M, Umezu H, Moriyama H, Takatsuka H, Takahashi K, et al. Macrophage differentiation and expression of macrophage colony-stimulating factor in murine milky spots and omentum after macrophage elimination. J Leukoc Biol 1997;61:436–444.
Doherty NS, Griffiths RJ, Hakkinen JP, Scampoli DN, Milici AJ. Post-capillary venules in the “milky spots” of the greater omentum are the major site of plasma protein and leukocyte extravasation in rodent models of peritonitis. Inflamm Res 1995;44:169–177. doi:10.1007/BF01782815.
Litbarg NO, Gudehithlu KP, Sethupathi P, Arruda JAL, Dunea G, Singh AK. Activated omentum becomes rich in factors that promote healing and tissue regeneration. Cell Tissue Res 1997;328:487–497. doi:10.1007/s00441-006-0356-4.
Zhang QX, Magovern CJ, Mack CA, Budenbender KT, Ko W, Rosengart TK. Vascular endothelial growth factor is the major angiogenic factor in omentum: mechanism of the omentum-mediated angiogenesis. J Surg Res 1997;67:147–154.
García-Gómez I, Goldsmith HS, Angulo J, Prados A, López-Hervás P, Cuevas B, et al. Angiogenic capacity of human omental stem cells. Neurol Res 2005;27:807–811. doi:10.1179/016164105X63674.
Logmans A, Schoenmakers CH, Haensel SM, et al. High tissue factor concentration in the omentum, a possible cause of its hemostatic properties. Eur J Clin Invest 1996;26:82–83. doi:10.1046/j.1365-2362.1996.107247.x.
Bikfalvi A, Alterio J, Inyang AL, Dupuy E, Laurent M, Hartmann MP, et al. Basic fibroblast growth factor expression in human omental microvascular endothelial cells and the effect of phorbol ester. J Cell Physiol 1990;144:151–158. doi:10.1002/jcp.1041440120.
Singh AK, Patel J, Litbarg NO, Gudehithlu KP, Sethupathi P, Arruda JA, Dunea G, et al. Stromal cells cultured from omentum express pluripotent markers, produce high amounts of VEGF, and engraft to injured sites. Cell Tissue Res 2008;332:81–88. doi:10.1007/s00441-007-0560-x.
Shimotsuma M, Simpson-Morgan MW, Takahashi T, Hagiwara A. Activation of omental milky spots and milky spot macrophages by intraperitoneal administration of a streptococcal preparation, OK432. Cancer Res 1992;52:5400–5402.
Florey H, Walker JL, Carleton HM. The nature of the movement of the omentum. J Pathol Bacteriol 1926;29:97–106. doi:10.1002/path.1700290111.
Oloumi MM, Derakhshanfar A, Molaei M, Tayyebi M. J Exp Anim Sci 2006;43(3):179–187. doi:10.1016/j.jeas.2006.02.002.
Matoba Y, Katayama H, Ohami H. Evaluation of omental implantation for perforated gastric ulcer therapy: findings in a rat model. J Gastroenterol 1996;31:777–784. doi:10.1007/BF02358602.
Epstein JC, Wilson MS, Wilkosz S, Ireland G, O’Dwyer ST, Herrick SE. Human peritoneal adhesions show evidence of tissue remodeling and markers of angiogenesis. Dis Colon Rectum 2006;49:1885–1892.
Cahill RA, Wang JH, Soohkai S, Redmond HP. Mast cells facilitate local VEGF release as an early event in the pathogenesis of postoperative peritoneal adhesions. Surgery 2006;140:108–112. doi:10.1016/j.surg.2006.01.020.
Chung DR, Chitnis T, Panzo RJ, Kasper DL, Sayegh MH, Tzianabos AO. CD4+ T cells regulate surgical and postinfectious adhesion formation. J Exp Med. 2002;195:1471–1478. doi:10.1084/jem.20020028.
Cahill RA, Redmond HP. Cytokine orchestration in post-operative peritoneal adhesion formation. World J Gastroenterol 2008;14:4861–4866. doi:10.3748/wjg.14.4861.
Benedet JL, Bender H, Jones H III, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO committee on gynecologic oncology. Int J Gynaecol Obstet 2000;70:209–262. doi:10.1016/S0020-7292(00)90001-8.
Hagiwara A, Sawai K, Sakakura C, Hagiwara A, Sawai K, Sakakura C, Shirasu M, Ohgaki M, Yamasaki J, et al. Complete omentectomy and extensive lymphadenectomy with gastrectomy improves the survival of gastric cancer patients with metastases in the adjacent peritoneum. Hepatogastroenterology 1998;45:1922–1929.
Lawrence RJ, Loizidou M, Cooper AJ, et al. Importance of the omentum in the development of intra-abdominal metastases. Br J Surg 1991;78:117. doi:10.1002/bjs.1800780135.
Hagiwara A, Takahashi T, Sawai K, Taniguchi H, Shimotsuma M, Okano S, et al. Milky spots as the implantation site for malignant cells in peritoneal dissemination in mice. Cancer Res 1993;53:687–692.
Dullens HF, Rademakers LH, Doffemont M, Van Veen PT, Bulder R, Den Otter W. Involvement of the omental lymphoid organ in the induction of peritoneal immunity against tumor cells. Invasion Metastasis 1993;13:267.
Krist LF, Kerremans M, Koenen HJ. Novel isolation and purifcation method to study functional cytotoxicity of macrophages from milky spots in the greater omentum. J Immunol Methods 1995b;184:253. doi:10.1016/0022-1759(95)00096-S.
Oosterling SJ, van der Bij GJ, Bögels M, van der Sijp JR, Beelen RH, Meijer S, et al. Ability of omental milky spots to prevent peritoneal tumor outgrowth supports omentectomy in minimal residual disease. Cancer Immunol Immunother 2006;55(9):1043–1051. doi:10.1007/s00262-005-0101-y.
Dullens HF, Rademakers LH, Cluistra S, Van Os R, Dux K, Den Besten PJ, Den Otter W. Parathymical lymph nodes during growth and rejection of intraperitoneally inoculated tumour cells. Invasion Metastasis 1991;11:216.
Tsjujimoto H, Hagiwara A, Shimutsuma M. Role of milky spots as selective implantation sites for malignant cells in peritoneal dissemination in mice. J Cans Res Clin Oncol 1996;122:590. doi:10.1007/BF01221190.
Lopes Cardozo AM, Gupta A, Koppe MJ. Metastatic pattern of CC531 colon carcinoma cells in the abdominal cavity: an experimental model of peritoneal carcinomatosis in rats. Eur J Surg Oncol 2001;27:359–363. doi:10.1053/ejso.2001.1117.
Krist LF, Kerremans M, Broekhuis-Fluitsma DM, Eestermans IL, Meyer S, Beelen RH. Milky spots in the greater omentum are predominant sites of local tumour cell proliferation and accumulation in the peritoneal cavity. Cancer Immunol Immunother 1998;47:205–212. doi:10.1007/s002620050522.
Bjorntorp P. Metabolic implications of body fat distribution. Diabetes Care 1991;14:1132–1143. doi:10.2337/diacare.14.12.1132.
Matsuzawa Y, Fujioka S, Tokunaga K, Tarui S. Classification of obesity with respect to morbidity. Proc Soc Exp Biol Med 1992;200:197–201.
Bastard JP, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, Capeau J, Feve B. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw 2006;17(1):4–12.
Harman-Boehm I, Blüher M, Redel H, Sion-Vardy N, Ovadia S, Avinoach E, Shai I, Klöting N, Stumvoll M, Bashan N, Rudich A. Macrophage infiltration into omental versus subcutaneous fat across different populations: effect of regional adiposity and the comorbidities of obesity. J Clin Endocrinol Metab 2007;92:2240–2247. doi:10.1210/jc.2006-1811.
Vohl MC, Sladek R, Robitaille J, Gurd S, Marceau P, Richard D, Hudson TJ, Tchernof A. A survey of genes differentially expressed in subcutaneous and visceral adipose tissue in men. Obes Res 2004;12(8):1217–1222. doi:10.1038/oby.2004.153.
Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S. Contribution of intraabdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism 1987;36:54–59. doi:10.1016/0026-0495(87)90063-1.
Kanai H, Matsuzawa Y, Kotani K, Keno Y, Kobatake T, Nagai Y. Close correlation of intra-abdominal fat accumulation to hypertension in obese women. Hypertension 1990;16:484–490.
He G, Pedersen SB, Bruun JM, Lihn AS, Jensen PF, Richelsen B. Differences in plasminogen activator inhibitor 1 in subcutaneous versus omental adipose tissue in non-obese and obese subjects. Horm Metab Res 2003;35(3):178–182. doi:10.1055/s-2003-39078.
Alessi MC, Bastelica D, Morange P, Berthet B, Leduc I, Verdier M, Geel O, Juhan-Vague I. Plasminogen activator inhibitor 1, transforming growth factor-beta1, and BMI are closely associated in human adipose tissue during morbid obesity. Diabetes 2000;49(8):1374–1380. doi:10.2337/diabetes.49.8.1374.
Gabrielsson BG, Johansson JM, Lönn M, Jernås M, Olbers T, Peltonen M, Larsson I, Lönn L, Sjöström L, Carlsson B, Carlsson LM. High expression of complement components in omental adipose tissue in obese men. Obes Res 2003;11(6):699–708. doi:10.1038/oby.2003.100.
Darimont C, Avanti O, Blancher F, Wagniere S, Mansourian R, Zbinden I, Leone-Vautravers P, Fuerholz A, Giusti V, Macé K. Contribution of mesothelial cells in the expression of inflammatory-related factors in omental adipose tissue of obese subjects. Int J Obes (Lond) 2008;32(1):112–120.
Gómez-Ambrosi J, Catalán V, Diez-Caballero A, Martinez-Cruz LA, Gil MJ, García-Foncillas J, Cienfuegos JA, Salvador J, Mato JM. Frühbeck Gene expression profile of omental adipose tissue in human obesity. G FASEB J 2004;18:215–217.
Bujalska IJ, Kumar S, Stewart PM. Does central obesity reflect “Cushing’s disease of the omentum”? Lancet 1997;349(9060):1210–1213. doi:10.1016/S0140-6736(96)11222-8.
Maury E, Ehala-Aleksejev K, Guiot Y, Detry R, Vandenhooft A, Brichard SM. Adipokines oversecreted by omental adipose tissue in human obesity. Am J Physiol Endocrinol Metab 2007;293(3):E656–E665. doi:10.1152/ajpendo.00127.2007.
McTernan CL, McTernan PG, Harte AL, Levick PL, Barnett AH, Kumar S. Resistin, central obesity, and type 2 diabetes. Lancet 2002;359:46–47. doi:10.1016/S0140-6736(02)07281-1.
Bergman RN, Van Citters GW, Mittelman SD, Dea MK, Hamilton-Wessler M, Kim SP, Ellmerer M. Central role of the adipocyte in the metabolic syndrome. J Investig Med 2001;49(1):119–126. doi:10.2310/6650.2001.34108.
Thörne A, Lönnqvist F, Apelman J, et al. A pilot study of long-term effects of a novel obesity treatment: omentectomy in connection with adjustable gastric banding. Int J Obes Relat Metab Disord 2002;26:193–199. doi:10.1038/sj.ijo.0801871.
Csendes A, Maluenda F, Burgos AM. Prospective Randomized Study Comparing Patients with Morbid Obesity Submitted to Laparotomic Gastric Bypass with or without Omentectomy. Obes Surg 2008;PMID: 18712575.
Maeda A, Ebata T, Kanemoto H, et al. Omental flap in pancreaticoduodenectomy for protection of splanchnic vessels. World J Surg 2005;29:1122–1126. doi:10.1007/s00268-005-7900-3.
Senn N. An experimental contribution to intestinal surgery with special reference to the treatment of intestinal obstruction. Ann Surg 1888;7:171–186.
Adams W, Ctercteko G, Bilous M. Effect of an omental wrap on the healing and vascularity of compromised intestinal anastomoses. Dis Colon Rectum 1992;35:731–738. doi:10.1007/BF02050320.
Katsikas D, Sechas M, Antypas G, et al. Beneficial effect of omental wrapping of unsafe intestinal anastomoses. An experimental study in dogs. Int Surg 1977;62(8):435–437.
Bhat MA, Dar MA, Lone GN, Dar AM. Use of pedicled omentum in esophagogastric anastomosis for prevention of anastomotic leak. Ann Thorac Surg 2006;82:1857–1862. doi:10.1016/j.athoracsur.2006.05.101.
Ferguson CM. Use of omental pedicle grafts in abdominoperineal resection. Am Surg 1990;56(5):310–312.
Logmans A, Lent van M, Geel van AN, Olofsel- van Acht M, et al. The pedicled omentoplasty, a simple and effective surgical technique to acquire a safe pelvic radiation field; theoretical and practical aspects. Radiother Oncol 1994;33:269–271. doi:10.1016/0167-8140(94)90364-6.
Lechner P, Cesnik H. Abdominopelvic omentopexy: preparatory procedure for radiotherapy in rectal cancer. Dis Colon Rectum 1992;35(12):1157–1160. doi:10.1007/BF02251968.
Tocchi A, Mazzoni G, Lepre L, Costa G, Liotta G, Agostini N, et al. Prospective evaluation of omentoplasty in preventing leakage of colorectal anastomosis. Dis Colon Rectum 2000;43:951–955. doi:10.1007/BF02237357.
Merad F, Hay JM, Fingerhut A, et al. Omentoplasty in the prevention of anastomotic leakage after colonic or rectal resection: a prospective randomized study in 712 patients. French Associations for Surgical Research. Ann Surg 1998;227:179–186. doi:10.1097/00000658-199802000-00005.
Christian CK, Kwaan MR, Betensky RA, et al. Risk factors for perineal wound complications following abdominoperineal resection. Dis Colon Rectum 2005;48:43–48. doi:10.1007/s10350-004-0855-x.
Bullard KM, Trudel JL, Baxter NN, et al. Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum 2005;48:438–443. doi:10.1007/s10350-004-0827-1.
Nilsson PJ. Omentoplasty in abdominoperineal resection: a review of the literature using a systematic approach. Dis Colon Rectum 2006;49:1354–1361. doi:10.1007/s10350-006-0643-x.
Ambroze WL Jr, Wolff BG, Kelly KA, et al. Let sleeping dogs lie: role of the omentum in the ileal pouch-anal anastomosis procedure. Dis Colon Rectum 1991;34:563–565. doi:10.1007/BF02049895.
Agalar F, Sayek I, Cakmakçi M, Hasçelik G, Abbasoglu O. Effect of omentectomy on peritoneal defence mechanisms in rats. Eur J Surg 1997;163:605–609.
Agca B, Paksoy M, Polat E, et al. Influence of omentectomy on peritoneal defense mechanisms in an experimental model of intra-abdominal infection. Eur Surg Res 2003;35:35–40. doi:10.1159/000067033.
Paksoy M, Hamzaoglu I, Cubukçu A, Uzun H, Agca B, Polat E, et al. The influence of omentectomy on the inflammatory phase of anastomotic healing. Hepatogastroenterology 2001;48:1359–1363.
Losken A, Carlson GW, Culbertson JH, et al. Omental free flap reconstruction in complex head and neck deformities. Head Neck 2002;24:326–331. doi:10.1002/hed.10082.
Ross WE, Pardo AD. Evaluation of an omental pedicle extension technique in the dog. Vet Surg 1993;22:37–43. doi:10.1111/j.1532-950X.1993.tb00366.x.
Das SK. The size of the human omentum and methods of lengthening it for transplantation. Br J Plast Surg 1976;29:144–170. doi:10.1016/0007-1226(76)90045-X.
Alday ES, Goldsmith HS. Surgical technique for omental lengthening based on arterial anatomy. Surg Gynecol Obstet 1972;135:103–107.
Topor B, Acland RD, Kolodko V, Galandiuk S. Omental transposition for low pelvic anastomoses. Am J Surg 2001;182:460–464. doi:10.1016/S0002-9610(01)00764-4.
Hultman CS, Carlson GW, Losken A, Jones G, Culbertson J, Mackay G, et al. Utility of the omentum in the reconstruction of complex extraperitoneal wounds and defects: donor-site complications in 135 patients from 1975 to 2000. Ann Surg 2002;235:782–795. doi:10.1097/00000658-200206000-00005.
Domene CE, Vlope P, Onari P, Szachnowicz S, Birbojm I, Barreira LF, et al. Omental flap obtained by laparoscopic surgery for reconstruction of the chest wall. Surg Laparosc Endosc 1998;8:215–218. doi:10.1097/00019509-199806000-00011.
Skoracki RJ, Chang DW. Reconstruction of the chest wall and thorax. J Surg Oncol 2006;94:455–465. doi:10.1002/jso.20482.
Shrager JB, Wain JC, Wright CD, Donahue DM, Vlahakes GJ, Moncure AC, et al. Omentum is highly effective in the management of complex cardiothoracic surgical problems. J Thorac Cardiovasc Surg 2003;125:526–532. doi:10.1067/mtc.2003.12.
Katz R, Borkowski T, Hoznek A, Salomon L, de la Taille A, Abbou CC. Operative management of rectal injuries during laparoscopic radical prostatectomy. Urology 2003;62:310–313. doi:10.1016/S0090-4295(03)00326-1.
Fujiwara K, Kigawa J, Hasegawa K, Nishimura R, Umezaki N, Ando M, et al. Effect of simple omentoplasty and omentopexy in the prevention of complications after pelvic lymphadenectomy. Int J Gynecol Cancer 2003;13:61–66. doi:10.1046/j.1525-1438.2003.13029.x.
Patsner B, Hackett TE. Use of the omental J-flap for prevention of postoperative complications following radical abdominal hysterectomy: Report of 140 cases and literature review. Gynecol Oncol 1997;65:405–407. doi:10.1006/gyno.1997.4700.
Casten DF, Alday ES. Omental transfer for revascularization of the extremities. Surg Gynecol Obstet 1971;123:301–304.
Singh I, Ramteke VK. The role of omental transfer in Buerger’s disease: New Delhi’s experience. Aust N Z J Surg 1996;66:372–376. doi:10.1111/j.1445-2197.1996.tb01214.x.
Talwar S, Jain S, Porwal R, et al. Pedicled omental transfer for limb salvage in Buerger’s disease. Int J Cardiol 2000;72:127–132. doi:10.1016/S0167-5273(99)00179-5.
Kitayama J, Morota T, Kaisaki S, Ishigami H, Yamashita H, Ishikawa M, et al. Complete coverage of in situ aortograft by total omental pedicle flap as the most reliable treatment of aortoesophageal fistula. Am J Surg 2006;192:130–134. doi:10.1016/j.amjsurg.2005.09.011.
Karasawa J, Touho H, Ohnishi H, Miyamoto S, Kikuchi H, Nakayama H. Cerebral revascularization using omental transplantation for childhood moyamoya disease. J Neurosurg 1993;79:192–196.
Goldsmith HS. Omental transposition in treatment of Alzheimer disease. J Am Coll Surg 2007;205:800–804. doi:10.1016/j.jamcollsurg.2007.06.294.
Salacinski HJ, Punshon G, Krijgsman B, Hamilton G, Seifalian AM. A hybrid compliant vascular graft seeded with microvascular endothelial cells extracted from human omentum. Artif Organs 2001;25:974–982. doi:10.1046/j.1525-1594.2001.06716.x.
Kobayashi T, Aomatsu Y, Iwata H, Kin T, Kanehiro H, Hisanga M, et al. Survival of microencapsulated islets at 400 days posttransplantation in the omental pouch of NOD mice. Cell Transplant 2006;15:359–365. doi:10.3727/000000006783981954.
Cheng Y, Liu YF, Zhang JL, Li TM, Zhao N. Elevation of vascular endothelial growth factor production and its effect on revascularization and function of graft islets in diabetic rats. World J Gastroenterol 2007;13:2862–2866.
Sigrist S, Mechine-Neuville A, Mandes K, Calenda V, Legeay G, Bellocq JP, et al. Induction of angiogenesis in omentum with vascular endothelial growth factor: influence on the viability of encapsulated rat pancreatic islets during transplantation. J Vasc Res 2003;40:359–367. doi:10.1159/000072700.
Baumert H, Simon P, Hekmati M, Fromont G, Levy M, Balaton A, et al. Development of a seeded scaffold in the great omentum: feasibility of an in vivo bioreactor for bladder tissue engineering. Eur Urol 2007;52:884–890. doi:10.1016/j.eururo.2006.11.044.
Motoshima H, Wu X, Sinha MK, Hardy VE, Rosato EL, Barbot DJ, Rosato FE, Goldstein BJ. Differential regulation of adiponectin secretion from cultured human omental and subcutaneous adipocytes: effects of insulin and rosiglitazone. J Clin Endocrinol Metab 2002;87(12):5662–5667. doi:10.1210/jc.2002-020635.
Matter CM, Handschin C. RANTES (regulated on activation, normal T cell expressed and secreted), inflammation, obesity, and the metabolic syndrome. Circulation 2007;115(8):1029–1038. doi:10.1161/CIRCULATIONAHA.106.685230.
Fried SK, Bunkin DA, Greenberg AS. Omental and subcutaneous adipose tissues of obese subjects release interleukin-6: depot difference and regulation by glucocorticoid. J Clin Endocrinol Metab 1998;83(3):847–850. doi:10.1210/jc.83.3.847.
GS Hotamisligil, NS Shargill, and BM Spiegelman Science 1 January 1993:Vol. 259. no. 5091, pp. 87 – 91 Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. GS Hotamisligil, NS Shargill, and BM Spiegelman
De Broux E, Parc Y, Rondelli F, Dehni N, Tiret E, Parc R. Sutured perineal omentoplasty after abdominoperineal resection for adenocarcinoma of the lower rectum. Dis Colon Rectum 2005;48:476–481. doi:10.1007/s10350-004-0784-8.
Hay JM, Fingerhut A, Paquet JC, Flamant Y. Management of the pelvic space with or without omentoplasty after abdominoperineal resection for carcinoma of the rectum: a prospective multicenter study. The French Association for Surgical Research. Eur J Surg 1997;163:199–206.
Wang JY, Huang CJ, Hsieh JS, Huang YS, Juang YF, Huang TJ. Management of the perineal wounds following excision of the rectum for malignancy. Gaoxiong Yi Xue Ke Xue Za Zhi 1994;10:177–181.
Rice ML, Hay AM, Hurlow RH. Omentoplasty in abdominoperineal resection of the rectum. Aust N Z J Surg 1992;62:147–149.
John H, Buchmann P. Improved perineal wound healing with the omental pedicle graft after rectal excision. Int J Colorectal Dis 1991;6:193–196. doi:10.1007/BF00341389.
Poston GJ, Smith SR, Baker WN. Retrocolic pelvic omentoplasty in abdominoperineal excision of the rectum. Ann R Coll Surg Engl 1991;73:229–232.
Smith SR, Swift I, Gompertz H, Baker WN. Abdominoperineal and anterior resection of the rectum with retrocolic omentoplasty and no drainage. Br J Surg 1988;75:1012–1015. doi:10.1002/bjs.1800751020.
Moreaux J, Horiot A, Barrat F, Mabille J. Obliteration of the pelvic space with pedicled omentum after excision of the rectum for cancer. Am J Surg 1984;148:640–644. doi:10.1016/0002-9610(84)90342-8.
Page CP, Carlton PK Jr, Becker DW. Closure of the pelvic and perineal wounds after removal of the rectum and anus. Dis Colon Rectum 1980;23:2–9. doi:10.1007/BF02587192.
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Collins, D., Hogan, A.M., O’Shea, D. et al. The Omentum: Anatomical, Metabolic, and Surgical Aspects. J Gastrointest Surg 13, 1138–1146 (2009). https://doi.org/10.1007/s11605-009-0855-1
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DOI: https://doi.org/10.1007/s11605-009-0855-1