Omentoplasty in thoracic surgery

Plombage methods were designed for treating pulmonary tuberculosis surgically around 1945 when pulmonary tuberculosis was regarded as a “traitor disease” in Japan. Nagaishi had reported extrapleural synthetic resin ball plombage in 1948 as the world’s first case, but it was complicated by empyema due to perforation of cavities and rupture of lesions because the resin ball was hard. Later, fillers were improved by using soft material. At the present time, only air plombage and omentoplasty remain. Especially the latter has gained widespread use in the thoracic surgery field and become a standard procedure. Chronic empyema with bronchopleural fistula sometime requires surgical treatment despite the development of various antibiotics, but highly stressful surgery that can cause reduced pulmonary function or thoracic deformity must be avoided. Therefore, one-stage omentoplasty utilizing such omental multifunctions as hose action, angiogenesis, sucker action, and the immune reaction has been found to have clinical significance for thoracic empyema and its complications. This method is described in detail.