Omentoplasty for thoracic problems: Usefulness of pedicled omentum and review of unsuccessful cases

We retrospectively studied the usefulness of pedicled omentum in the management of thoracic problems. From 1998 to 2001, 23 patients (19 male and 4 female, mean age 65.1 years) underwent omentoplasty for the management of thoracic problems in our hospital. They consisted of 19 patients with empyema and/or bronchopleural fistula (chronic empyema 10, postoperative empyema 6, late bronchopleural fistula 3), 2 patients with non-infective fistula (lung 1, esophagus 1), and 2 patients with preventive reinforcement of bronchial stump/ anastomosis. Of 19 patients with empyema 16 had airleak. Eleven patients underwent omentoplasty after staged thoracostomy, 5 underwent omentoplasty after infection control with tube drainage, and 3 underwent omentoplasty with active infection. Fifteen of 19 patients with empyema and/or bronchopleural fistula achieved closure of the thorax with infection control. The patients with non-infective lung parenchimal fistula and preventive reinforcement of the bronchial stump/anastomosis obtained freedom from airleak, while the patient with non-infective esophageal fistula was unsuccessful. The main causes of failure in the 4 patients with empyema who required thoracostomy were ischemia of the pedicled omentum and residual infection. Abdominal complication occurred in 2 patients (8.7%); one was perforating peritonitis and the other was strangulating intestinal obstruction, both of which required enterectomy. Omentoplasty is effective in the management of thoracic problems, however, it remains ineffective in some patients with empyema and contains some complications. Attention should be paid to the transposition of pedicled omentum. It is preferable to use omentum for empyema after infection control.