The objective of this systematic review and meta-analysis was to examine the effects of omentoplasty
on pelviperineal morbidity following abdominoperineal resection
(APR) in patients with cancer.
Recent studies have questioned the use of omentoplasty
for the prevention of perineal wound complications.
A systematic review of published literature since 2000 on the use of omentoplasty
during APR for cancer was undertaken. The authors were requested to share their source patient data. Meta-analyses were conducted using a random-effects model.
Fourteen studies comprising 1894 patients (n = 839 omentoplasty
) were included. The majority had APR for rectal cancer (87%). Omentoplasty
was not significantly associated with the risk of presacral abscess
formation in the overall population (RR 1.11; 95% CI 0.79–1.56), nor in planned subgroup analysis (n = 758) of APR with primary perineal closure for nonlocally advanced rectal cancer (RR 1.06; 95% CI 0.68–1.64). No overall differences were found for complicated perineal wound healing
within 30 days (RR 1.30; 95% CI 0.92–1.82), chronic perineal sinus (RR 1.08; 95% CI 0.53–2.20), and pelviperineal complication necessitating reoperation (RR 1.06; 95% CI 0.80–1.42) as well. An increased risk of developing a perineal hernia
was found for patients submitted to omentoplasty
(RR 1.85; 95% CI 1.26–2.72). Complications related to the omentoplasty
were reported in 4.6% (95% CI 2.5%–8.6%).
This meta-analysis revealed no beneficial effect of omentoplasty
on presacral abscess
formation and perineal wound healing
after APR, while it increases the likelihood of developing a perineal hernia
. These findings do not support the routine use of omentoplasty
in APR for cancer.