M. Bruzoni1, G. Steinberg2, S. Dutta1 1Stanford University School Of Medicine,Pediatric Surgery,Stanford, CA, USA 2Stanford University School Of Medicine,Neurosurgery,Stanford, CA, USA
Introduction: An abundance of angiogenic and immunologic factors make the omentum an ideal tissue for reconstruction and revascularization of a variety of extraperitoneal wounds and defects. Omental harvesting has historically been performed through a large laparotomy with subcutaneous tunneling to the site of disease. Complications of the open procedure include abdominal wound infection, fascial dehiscence, ventral hernia, and postoperative ileus. The use of laparoscopy to harvest the omentum has the potential to reduce such complications. We describe the outcomes of a series of patients undergoing laparoscopic pedicled omental flap mobilization for cerebral revascularization in moyamoya disease.
Methods: A retrospective chart review of all patients undergoing laparoscopic omental-cerebral transposition for moyamoya disease between 2011 and 2014 was performed. Clinical indication, surgical technique, operative times, complications, and outcomes at follow-up were reviewed.
Results: Seven consecutive patients ages 5 to 13 years underwent the procedure. The general surgery team performed laparoscopic omental mobilization, extraperitonealization, and subcutaneous tunneling while the neurosurgical team performed craniotomy and cerebral application of the graft. The omental flap measured up to 60 cm in length. Operative times for the omental transposition ranged from 125 to 200 minutes. The patients were followed up postoperatively with clinic visits and angiography. There was one intraoperative complication (mesocolon injury requiring segmental resection in a patient with prior peritonitis) and no postoperative complications. All patients had significant to complete symptomatic resolution, and demonstrated adequate pedicle-based revascularization on angiography.
Conclusion: Laparoscopic pedicled omental mobilization and subcutaneous transposition is feasible and effective in children who require cerebral revascularization for moyamoya disease. Morbidity from a large laparotomy is avoided. A similar approach to extraperioneal revascularization of other distant sites is plausible.