Omentoplasty in rectal cancer surgery prolongs post-operative ileus

Abstract

Backgrounds and aim: Omentoplasty is frequently used as a safeguard in rectal cancer surgery for wrapping the anastomosis or filling up the pelvic cavity. The omentum is known for its infection defence and haemostatic and angiogenic properties. A disadvantage was hypothesized to be prolonged post-operative ileus, as omentoplasty interrupts the blood flow from an epiploic artery to the stomach.

Materials and methods: Patients who had had an uncomplicated surgical treatment for primary rectal cancer between January 2006 and March 2007 were included. Clinical parameters of post-operative ileus were collected and compared between procedures with a concomitant omentoplasty (n = 31) and without (n = 20).

Results: Patients needed their gastric tube significantly longer after omentoplasty than those without (3.9 vs 1.6 days, p < 0.001). Similar significant results were found for time to normal diet (p = 0.004), time to first discharge of faeces (p = 0.007), need for parenteral feeding (p = 0.036) and length of hospital stay (p = 0.008). Furthermore, there was a non-significant trend for more days to first discharge of air (3.4 vs 2.4 days, p = 0.165). There were no significant differences in patients' and procedure characteristics, except for more low anterior resections in the group without an omentoplasty (p < 0.001). None of these characteristics had any clinically relevant interference with the parameters of post-operative ileus.

Conclusion: A trend for prolonged post-operative ileus was found in patients who underwent an omentoplasty concomitant with their treatment for primary rectal cancer. When assessing the importance of omentoplasty in the future, post-operative ileus should be taken into account.