BACKGROUND: PD catheter tip migration is a common complication and a significant cause of catheter malfunction. In this perspective, we present our experience with a new catheter and a new technique that involves the use of a new triple cuff PD catheter and a low entry site in an attempt to prevent PD catheter migration.
METHODS: A total of 503 incident PD patients have been studied in more than one PD center over a period of 5 years.
RESULTS: During the 5-year follow up we recorded zero percent catheter migration. Other technical complications were poor drainage in 3.4%, omental wrap in 2.8%, early leakage in 3.4%, and catheter replacement in 2.4%. By the end of the study, the one-year PD catheter survival was 97.6%.
CONCLUSIONS: Our new triple cuff PD catheter and our low-entry approach seem to be effective in preventing PD catheter migration and minimizing other mechanical complications.

UNASSIGNED: This study aimed to determine the feasibility of performing omentectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for surgical staging of ovarian and high-risk endometrial malignancies.
UNASSIGNED: This descriptive study was realized in a non-university hospital in Switzerland. Eighteen patients with suspicious adnexal masses or high-risk endometrial cancer underwent surgical staging comprising infracolic omentectomy by vNOTES between May 2020 and April 2023.
UNASSIGNED: Patients underwent oncological surgical staging for suspicious adnexal masses in 14 cases (77.8%) and high-risk endometrial cancer in 4 cases (22.2%). vNOTES omentectomies were performed in all patients without complications. Associated procedures included salpingo-oophorectomy (94.4%), hysterectomy (55.6%), peritoneal biopsies (33.3%), pelvic sentinel lymph node biopsies (22.2%), and appendectomy (5.6%). The median time to perform omentectomies was 9 (4-13) min. All oncological staging were completed by vNOTES. No significant intraoperative complications occurred. We observed 1 case (5.6%) of postoperative fever probably associated with vaginal cuff infection (Clavien-Dindo grade II).
UNASSIGNED: This study demonstrated the feasibility of performing vNOTES oncological staging requiring complex extrapelvic procedures such as infracolic omentectomy, supporting its potential role for managing gynecological malignancies such as ovarian and high-risk endometrial cancers. However, before expanding this approach outside study settings, strong evidence of its feasibility, practical benefits, and long-term oncological outcomes are needed.

BACKGROUND: Curative therapy for gastric cancer usually consists of perioperative chemotherapy combined with a radical (R0) gastrectomy. In addition to a modified D2 lymphadenectomy, a complete omentectomy is recommended. However, there is little evidence for a survival benefit of omentectomy. This study presents the follow-up data of the OMEGA study.
METHODS: This multicenter prospective cohort study included 100 consecutive patients with gastric cancer undergoing (sub)total gastrectomy with complete en bloc omentectomy and modified D2 lymphadenectomy. Primary outcome of the current study was 5-year overall survival. Patients with or without omental metastases were compared. Pathological factors associated with locoregional recurrence and/or metastases were tested with multivariable regression analysis.
RESULTS: Of 100 included patients, five had metastases in the greater omentum. Five-year overall survival was 0.0% in patients with omental metastases and 44.2% in patients without omental metastases (p = 0.001). Median overall survival time for patients with or without omental metastases was 7 months and 53 months. A (y)pT3-4 stage tumor and vasoinvasive growth were associated with locoregional recurrence and/or metastases in patients without omental metastases.
CONCLUSIONS: The presence of omental metastases in gastric cancer patients who underwent potentially curative surgery was associated with impaired overall survival. Omentectomy as part of radical gastrectomy for gastric cancer might not contribute to a survival benefit in case of undetected omental metastases.

This study assessed the effect of omentectomy on the prognosis and fertility in patients with clinically early-stage (I, II) malignant ovarian germ cell tumours (MOGCT).
A retrospective multicentre study.
Four university teaching hospitals in China.
A total of 268 patients with clinically apparent early-stage (I, II) MOGCT.
Data were obtained from the medical records. Additionally, the propensity score matching (PSM) algorithm was adopted.
Prognostic outcomes were disease-free survival (DFS) and overall survival (OS). Fertility outcomes were pregnancy and live birth rates.
A total of 187 (69.8%) patients underwent omentectomy. Kaplan-Meier analysis showed no significant differences in DFS and OS between the omentectomy and non-omentectomy groups before and after PSM (p > 0.05). Additionally, subgroup analysis stratified by age (<18 and ≥18 years) showed similar results. International Federation of Gynecology and Obstetrics (FIGO) stage was the only risk factor associated with DFS (hazard ratio [HR] 14.71, 95% confidence interval [CI] 4.47-48.38, p < 0.001) and OS (HR 37.36, 95% CI 3.87-361.16, p = 0.002). Pregnancy and live birth rates in the total population were 80.3% and 66.7%, respectively. There were no significant differences between the two groups before and after PSM.
Omentectomy did not improve survival or affect fertility in patients with clinically apparent early-stage (I, II) MOGCT, regardless of the age. The clinical FIGO stage was an independent risk factor for recurrence and death.

BACKGROUND: There are no multi-center studies examining omentectomy and peritoneal dialysis (PD) catheter revision in the pediatric dialysis population.
METHODS: We performed a retrospective study at eight centers within the Pediatric Nephrology Research Consortium (PNRC). Data review included all incident tunneled PD catheters placed between 1/1/2011 and 12/31/2016 in pediatric stage 5 chronic kidney disease (CKD 5) patients. The primary outcome was the need for catheter revision and/or replacement. Multivariable logistic regression was performed to evaluate predictors for catheter revision/replacement.
RESULTS: Data from 184 children (62.5% male; median age 7.4 years) were analyzed. Omentectomy was completed in 63.6% (n = 117). Revision/replacement occurred in 34.2% (n = 63); median time to revision/replacement was 38.5 days after insertion. PD catheter revision/replacement catheter occurred in 23.9% who underwent omentectomy versus 52.2% without omentectomy (p = 0.0005). Children ≥ 6 years at the time of catheter insertion experienced fewer revisions/replacements (18.2% age ≥ 6 vs. 56.5% age < 6 years, p <0.001). After adjusting for covariates, omentectomy reduced the need for revision by 63%; revision was 3.66 times more likely in those < 6 years of age.
CONCLUSIONS: This multi-center study demonstrates that omentectomy at the time of PD catheter insertion in pediatric patients is strongly associated with reduced likelihood of PD catheter revision. Omentectomy should be considered at the time of PD catheter insertion, especially in young children who are at high risk for PD catheter malfunction. A higher resolution version of the Graphical abstract is available as Supplementary information.

Although complete omentectomy is traditionally performed in patients with gastric cancer as part of radical gastrectomy to ensure the elimination of micrometastases, the prognostic value of omentectomy during gastrectomy remains unclear. Retrospective studies have shown that the incidence of metastases in the greater omentum is very low in T1-T3 gastric cancer. Thus radical gastrectomy with D2 lymphadenectomy and preservation of the greater omentum may be a proper curative treatment for gastric cancer patients with T1-T3 tumors. The aim of this article is to describe the design and rationale for this prospective, randomized controlled DRAGON-05 trial, conducted to evaluate the prognostic value of omentum-preserving gastrectomy for patients with T1-T3 gastric cancer. Clinical trial registration: ChiCTR2000040045 (ClinicalTrials.gov).

Gastrectomy with omentectomy and D2 lymph node dissection is the current standard procedure for locally advanced gastric cancer. However, some retrospective studies have reported that omentectomy increased post-operative abdominal complications but provided no survival advantage over omentum preservation. Therefore, we plan a randomized controlled phase III trial to confirm the non-inferiority of omentum preservation compared with omentectomy in patients with cT3 (SS) or cT4a (SE) gastric cancer. A total of 1050 patients will be enrolled from 62 institutions over a period of 6.5 years. The primary end point is relapse-free survival, and the secondary end points are overall survival, blood loss, operation time and adverse events. This trial has been registered at the UMIN Clinical Trials Registry as UMIN000036253.

BACKGROUND: Surgical treatment for adhesive small bowel obstructions (ASBOs) is the only way to release the obstructive structure; however, opening the peritoneal cavity may cause new adhesions, possibly leading to recurrent episodes of ASBO. The risk factors for recurrent ASBO, after surgical treatment, are not fully understood.
METHODS: The hospital records of 113 patients undergoing surgery for ASBO at Shirakawa Kousei (Japan) General Hospital, between 2002 and 2013, were studied. We compared the pre- and postoperative factors, intraoperative findings, and surgical histories of 18 patients with and 95 patients without recurrent ASBO. The risk factors for ASBO recurrence, after surgery, were determined using Cox-proportional hazard ratios.
RESULTS: The 5-year cumulative rate of overall recurrence was 20.8%. Among the 18 patients of recurrence, 11 (61.1%) were readmitted within 1 year of surgical treatment. Multivariate analysis revealed that a history of omentectomy was an independent risk factor for recurrence (hazard ratio, 2.98; p = 0.027). After omentectomy, the rate of adhesions to the peritoneum was significantly higher (with omentectomy, 54.5%; without omentectomy, 21.3%; p < 0.001), and the risk of adhesion or matted adhesion was increased (with omentectomy, 87.9%; without omentectomy, 53.8%; p < 0.001), compared with patients not undergoing omentectomy.
CONCLUSIONS: Omentectomy significantly increases the likelihood of ASBO recurrence. Therefore, patients undergoing omentectomy may be candidates for prophylactic anti-adhesion agents, particularly when there is a risk of matted abdominal wall adhesions.

OBJECTIVE: Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease. The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation (RYGB) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone.
METHODS: Eighty-one obese women scheduled for RYGB were included in the study. They were randomized to RYGB or RYGB in conjunction with omentectomy. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined 2 years post-operatively. The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors.
RESULTS: Two-year weight loss was profound but unaffected by omentectomy. Before intervention, there were no clinical or metabolic differences between the two groups. The difference in primary outcome measure, insulin sensitivity, was not significant between the non-omentectomy (6.7 ± 1.6 mg/kg body weight/minute) and omentectomy groups (6.6 ± 1.5 mg/kg body weight/minute) after 2 years. Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly.
CONCLUSIONS: Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors. The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable.
BACKGROUND: NCT01785134.