• Robin D Blok, Jan A W Hagemans, Klaver Charlotte E L CEL Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Joke Hellinga, Boudewijn van Etten, Burger Jacobus W A JWA Department of Surgical Oncology, Erasmus Medical Center, Cancer Institute, Rotterdam, The Netherlands. , Cornelis Verhoef, Roel Hompes, Wilhelmus A Bemelman, and Pieter J Tanis.
• Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
• Ann. Surg. 2020 Apr 1; 271 (4): 654-662.

ObjectiveThe 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.BackgroundRecent studies have questioned the use of omentoplasty for the prevention of perineal wound complications.MethodsA 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.ResultsFourteen 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%).ConclusionsThis 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.

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