What is Omentectomy? - Surgery, Procedure and Side Effects

There are two layers of the omentum:

1. Greater omentum: It attaches the stomach to the transverse colon. 
2. Lesser omentum: It attaches the stomach and duodenum to the liver.  

1. A doctor may recommend an omentectomy for a patient with ovarian cancer if the cancerous cells have spread to the omentum. 
2. It is also performed to determine the stage of ovarian cancer. 

Surgical Options for Omentectomy

1. Open Omentectomy: This is a traditional approach to omentectomy where the surgeon makes a single large incision in the abdomen. 
2. Minimally Invasive Omentectomy: It is a laparoscopic approach to omentectomy in which the surgeon performs the surgery through several small incisions. It has several benefits, including less scarring and shorter recovery time. 

Mostly omentectomy is performed at the same time as the surgery to remove the primary tumour from the ovary. 

Before Omentectomy

1. Before an omentectomy, you will meet the medical team involved with your surgery. 
2. Your doctor will advise you for a pre-anaesthetic checkup. 
3. They will enquire about your medical history, medications, supplements, and herbal products. 
4. You may have to get some tests done to check whether you’re fit for the surgery. These tests include:
   1. Blood tests
   2. Breathing tests
   3. Chest X-ray
   4. Cardiopulmonary exercise test (to measure heart and lung function)
   5. Echocardiogram (to monitor your heart)
5. Your health professional may recommend you stop smoking or drinking alcohol a couple of weeks before the surgery. 
6. You may be asked to do breathing exercises to prevent developing a lung infection after the surgery. 
7. The doctor will ask you to stop taking certain medications, such as non-steroidal anti-inflammatory drugs and blood thinners, to reduce your risk of bleeding. 
8. Make sure to not eat or drink anything after midnight on the night before the procedure. 
9. The doctor will briefly explain the procedure, hospital stay, estimated cost, and insurance formalities. 

What Can You Expect on the day of the surgery?

1. The hospital team will ask you to sign a consent form, giving your permission for the surgery. 
2. The nursing staff will ask you to remove all jewellery pieces and change your clothes into a hospital gown. 
3. Your healthcare team will ask you to empty your bladder before the procedure. 
4. Someone from the team will shave the hair in the incision site. 
5. The doctor will record your last meal. 
6. If there are medications that you can take on the day of the surgery, take them with a small sip of water. 
7. The anaesthesiologist will monitor your vitals, including heartbeat, breathing, and blood pressure. 
8. The team will shift you to the OT room. 

What Can You Expect During the Surgery?

1. The team will place you on the operating table in the OT room. 
2. An IV line will be administered in your arms or hands for fluids and medications. 
3. The anaesthesiologist will give you anaesthesia to make you sleep through the procedure. 
4. Someone from the team will clean the surgical site with an antiseptic solution. 
5. The anaesthesiologist will monitor your vitals throughout the procedure. 
6. The surgeon will make several smaller incisions for a laparoscopic approach or a single large incision in the abdomen for a traditional approach. 
7. They will then perform the surgery and remove a part or all of the omentum. 
8. During omentectomy, you may also undergo peritoneal washing, where the surgeon will inject a sterile fluid into your abdomen, remove it, and send it back to a lab to look for unhealthy cells. 
9. The surgeon will close the cuts and apply a dressing. 

There are two types of omentectomy surgery:

1. Total or Supracolic Omentectomy: The surgeon removes the entire omentum in this procedure. 
2. Partial Omentectomy: The surgeon removes a part of the omentum in partial omentectomy, targeting a specific area. 

Omentectomy may be performed either traditionally, i.e., through a single incision in the abdomen, or laparoscopically, i.e., through multiple small incisions. 

An omentectomy may be performed with other surgeries to stage or cure ovarian cancer. The procedures include:

1. Salpingo-oophorectomy: used to remove the ovaries and fallopian tube
2. Hysterectomy: used to remove the uterus and cervix
3. Lymph node dissection: used to remove lymph nodes
4. Cytoreductive/ debulking surgery: used to remove cancer that has spread to other abdominal areas. 

In the Hospital

1. After the surgery, the team will move you to the recovery room to monitor your vitals and the effect of anaesthesia. 
2. The team will shift you to the hospital ward when you are fully awake. 
3. You may need to stay in the hospital for two to four days. 
4. You will experience some pain post-surgery, but the doctor will prescribe pain medications to manage it. 
5. You will need IV fluids until you can drink enough to meet your body’s needs. 
6. You may experience numbness around the incision, which will improve over the next few months. 
7. You will be taught leg exercises to prevent the formation of blood clots. 
8. If a part of your bladder is taken out, you will need a thin tube (a catheter) in the bladder to drain urine until it begins to function properly. 
9. If a part of your colon is removed, you may need to wear a colostomy bag temporarily. 
10. After an omentectomy, your doctor may recommend chemotherapy to destroy any residual cancer cells. 
11. Usually, chemotherapy drugs are injected into a vein or delivered to your abdomen via a catheter. 

At Home

1. Your doctor will prescribe pain medications to manage pain once you go home. 
2. You may take a shower to keep the incisions clean. 
3. Make sure to pat dry your incisions after washing. 
4. The catheter may remain in place for about seven days after the surgery. 
5. Your provider may ask you to not drive for the first few weeks after the surgery, especially while on pain medications. 
6. Do not engage in heavy lifting for the first six weeks after the surgery. 
7. You can gradually increase your exercise. 
8. Recovery from an omentectomy varies depending on the procedures you’ve had in addition. 
9. If you had a salpingo-oophorectomy or hysterectomy during the same procedure, you might take as long as eight weeks to return to your normal activities. 

First Follow-Up Appointment

The doctor will typically schedule your first follow-up appointment three to four weeks after the surgery. During this visit, your surgeon will review the pathologist’s report and do a physical examination to ensure that your incisions are healing properly. 

What are the Chances of Recurrence?

1. Even after omentectomy surgery and other treatments, tumours have a small chance of returning. When the cancer is no longer detected in your body, or there are no symptoms, you have “no evidence of disease” or NED.
2. You can either be temporarily or permanently in the NED stage. After the surgery, your doctors will conduct more tests to assess your stage and likeliness of recurrence.
3. The chances of recurrence differ with each individual based on multiple factors, including the type of cancer and genetics. 

An omentectomy is a relatively safe procedure. However, some possible complications of omentectomy include:

1. Pain
2. Nerve damage that could be permanent
3. Damage to nearby organs
4. Infection
5. Nausea
6. Some bleeding
7. Lymphedema (buildup of fluid caused by blockade of lymph vessels)

When to Consult a Doctor?

Call your healthcare professional if you experience:

1. Fever above 100.4℉
2. Severe nausea, vomiting, or stomach pain
3. Redness or swelling around the incision site 
4. Drainage from the incision site
5. Heavy bleeding

The cost of Omentectomy ranges from ₹4,00,000 to ₹6,00,000. The cost varies based on the following factors:

1. Type of Omentectomy surgery
2. Age of the patient
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.