Overview

Omentectomy is a type of surgery that involves the removal of the big fatty layer in the belly called the omentum, along with some lymph nodes. Omentectomy in some cases has been known to get rid of cancer cells during advanced stomach surgery.¹

As a special organ in the belly, the omentum controls inflammation, foreign bodies, and tumours. It is commonly believed that the omentum should be removed when there is tumour invasion, its overall impact on treating belly issues should be examined more closely.² While the greater omentum helps protect the abdomen by sticking to inflamed areas and absorbing harmful substances, it's often where cancer comes back or starts to spread in digestive system cancers.³

The omentum is like a protective shield in the belly. It has special spots with different types of cells that help fight off infections. When the entire omentum is removed, it makes one prone to getting belly infections, making things worse for the overall well-being. Therefore, even though taking out the omentum might help with cancer, it also makes you more at risk for infections.¹ The omentum is often the first organ taken out during cytoreductive surgery (CRS). It's an organ that can be easily removed in different abdominal surgeries.²

Purpose of omentectomy

Firstly, omentectomy is a surgical procedure used in the treatment of cancer. Some research studies have found that cancer cells found in the stomach tend to grow more in the omentum, especially in these special spots called milky spots.¹

Secondly, Inflammatory conditions can be treated with the removal of the omentum to stop infections and keep them in control if an infection has badly harmed the omentum. In some stories, doctors had to do a big belly surgery (laparotomy) because of infections caused by a certain bacterium (Burkholderia pseudomallei). When they find a lump during this surgery and it looks like a tumour in the omentum, they might decide to do an omentectomy. Also, in people with a stomach disease called abdominal tuberculosis, the omentum can seem like there's a tumour in the ovaries.²

Procedure of omentectomy

Before an omentectomy is performed, the cancer care team will check if one is physically ready for surgery, ensuring you can handle anaesthesia and recover well.

Tests before omentectomy may include:

• Blood work
• Breathing tests
• Heart assessments.

These are some of the steps to prepare for omentectomy surgery:

• Ask questions about the procedure, hospital stay, other treatments, pain, and additional procedures
• Check if you need to stop smoking or drinking before surgery
• Inquire about breathing and leg exercises to prevent infections and blood clots
• Pack personal items for the hospital stay
• Arrange for childcare, home, and pet care
• Confirm which medications to take before surgery, considering those that may increase bleeding risk

These preparations help ensure a smoother omentectomy experience and recovery.

Surgical process

The surgery can be done in three ways:

• Laparoscopic or robotic-assisted laparoscopic, with small belly incisions⁴
• Traditional surgery, with one larger belly incision.
• Additional surgeries, like removing ovarian cancer, may happen simultaneously²
• Surgical treatment aims to eliminate cancer by removing affected tissues.

The operation may mark the end or the beginning of your treatment journey depending on the type of cancer you have. There are several potential benefits associated with omentectomy itself, despite its relatively simple nature.

Types of omentectomy

• Partial omentectomy removes only a part of the omentum and is less invasive
• Total omentectomy takes out the whole omentum and is more invasive^1,5

Importance of omentectomy

Omentectomy is used as a diagnostic tool in detecting if cancer is present in the omentum. When the omentum is removed, it can be taken for further analysis and the right diagnosis can be made.

In addition, it is used to detect the right stage of cancer, especially ovarian cancer. For early-stage cancer, a peritoneal wash may be done to check if the cancer has spread, involving washing the abdominal cavity with sterile saltwater and analysing it in the lab.

It is used for therapeutic purposes as well since it can help in disease prevention as well as alleviation of symptoms. It helps reduce the risk of cancer spreading to other organs, especially colorectal cancer.²

Risks and complications

While omentectomy helps remove cancer from the omentum or generate the best treatment, there are risks of side effects or complications.

Side effects can include:

• Temporal discomfort
• Fluid retention
• Bathroom difficulties
• Risk of bleeding during or after surgery
• Nerve damage
• A possible recurrence of bowel obstruction due to scar tissue.
• Risks of infection at the site of incision⁴
• Adhesions can occur when organs stick together²

Recovery and aftercare

Recovery time after the surgery depends on the type and extent of the procedure. The recovery time from smaller operations, like laparoscopic ones, may be a few weeks, but up to eight weeks may be required for major operations that remove multiple organs.

After an omentectomy, it's crucial to steer clear of activities that might strain the belly muscles and slow down healing. Avoid lifting heavy things, driving, swimming, and doing intense exercise. Also, skip alcohol and smoking, as these can delay healing and raise the risk of problems. Follow your doctor's advice and stick to your recovery plan for a successful healing process. Rehabilitation may be necessary in some cases. 

FAQs

What is omentectomy?

Omentectomy is a surgery to take out the omentum, a fatty tissue layer covering the organs in the belly. It's done to lower the risk of cancer or to treat cancer that has reached the omentum.

Why is the omentum removed?

If there is cancer in your omentum or there is a risk it might spread there, your doctor might suggest removing it through surgery. This can help prevent the cancer from spreading. Sometimes, they take out the omentum to check for tiny signs of cancer, which helps them figure out the cancer stage and plan the right treatment.

Are there risks with omentectomy?

Yes, like any surgery, omentectomy can have risks like infection, bleeding, or damage to nearby organs. There's also a chance of complications such as adhesions, hernias, or bowel obstruction. However, these risks are uncommon and can be reduced with good care and follow-up.

Operations combined with Omentectomy

Associated surgeries with omentectomy include hysterectomy (removal of the womb), salpingectomy (removal of the uterine tubes), oophorectomy(removal of the ovary), prostatectomy (removal of the prostate), gallbladder removal, colectomy (removal of the colon), retroperitoneal lymph node dissection (remove lymph nodes), and cytoreductive surgery (debulking, the reduction of tumour size).

Does the omentum grow back?

No, your omentum cannot grow back after surgery. Although the peritoneal tissue, which includes the omentum, heals quickly, once it's removed, it doesn't regenerate.

Can I still have kids after an omentectomy?

Yes, except the procedure is done alongside a hysterectomy (surgical removal of the womb). Adoption and in-vitro fertilisation can be considered as an alternative in such a case.

How does omentectomy benefit one’s life?

Omentectomy lowers the risks of cancer and improves general well-being which can help improve the quality of one’s life.

What happens in omentectomy recovery?

There are tendency for discomfort, swelling, bruising, or fatigue after the surgery. Your doctor may prescribe pain meds, wearing a compression garment, or physical therapy to help manage symptoms and boost recovery.

Summary

Omentectomy is a surgical procedure involving the removal of the omentum, a fatty tissue layer in the abdomen. It is commonly performed in the context of cancer treatment, especially when cancer has spread to the omentum or to determine the stage of the disease. The omentum plays a role in limiting infections and controlling inflammatory processes. The surgery can be partial or total and is often combined with other procedures, depending on the specific medical condition. Recovery time varies, and the procedure is considered an important part of cancer management, though its overall impact on various abdominal pathologies is subject to ongoing research and evaluation.