What is an omentopexy procedure?

September 30, 2025 •

5 min read

According to a 2021 meta-analysis, the addition of omentopexy to laparoscopic sleeve gastrectomy was associated with a significantly lower rate of gastric leakage. An omentopexy procedure is a surgical technique involving the fixation of the omentum to another organ or the abdominal wall to achieve a specific therapeutic goal.

Quick Summary

Omentopexy is a surgical operation that anchors the omentum, a fatty abdominal tissue, to a different organ or the abdominal wall. This technique is used to stabilize organs, improve blood flow, prevent complications like catheter obstruction, and aid in healing after certain gastrointestinal surgeries.

Key Points

Surgical Fixation: An omentopexy procedure involves surgically attaching the omentum, a fatty abdominal tissue, to a nearby organ or the abdominal wall.
Multiple Applications: The procedure is used in bariatric surgery to prevent leaks and stabilize the stomach, in peritoneal dialysis to prevent catheter obstruction, and in other surgeries to aid healing.
Minimally Invasive Option: Omentopexy can be performed laparoscopically, which is a minimally invasive approach that can lead to faster recovery and fewer complications compared to open surgery.
Complication Prevention: It is primarily performed to prevent post-operative issues such as gastric volvulus, catheter wrapping, and anastomotic leakage.
Rich Blood Supply: The effectiveness of omentopexy comes from the omentum's excellent blood supply, which helps promote healing and seal surgical sites.
Versatile Technique: Depending on the need, the omentum can be fixed with sutures, clips, or surgical tacks, and the technique varies widely based on the main surgical procedure.

What is the omentum?

The omentum is a large fold of fatty tissue that hangs like an apron from the stomach and drapes over the intestines. The greater omentum is a particularly large, double-layered structure that is highly vascularized, meaning it has a rich blood supply. This unique structure allows it to play a significant role in the immune system and wound healing within the abdominal cavity. Its ability to absorb fluids, adhere to damaged areas, and promote the formation of new blood vessels makes it a powerful asset in surgical procedures.

The Purpose of Omentopexy

At its core, an omentopexy is performed to achieve one of several surgical goals by strategically using the omentum. The primary reasons a surgeon might perform this procedure include:

Stabilization: Fixing an organ in place to prevent future displacement. This is particularly relevant in veterinary medicine for correcting a displaced abomasum (stomach) in ruminants, but also has applications in human surgery.
Complication Prevention: Anchoring the omentum can prevent it from causing issues after other procedures. For instance, in peritoneal dialysis, it prevents the omentum from wrapping around and obstructing the catheter. In bariatric surgery, it is used to reduce the risk of staple line complications.
Improved Healing: Due to its rich blood supply, the omentum can be wrapped around a surgical site (like an anastomosis) to promote wound healing and reduce the risk of leakage.
Enhanced Circulation: By suturing the omentum to the abdominal wall, a surgeon can encourage circulation away from the portal system and into the caval circulation.

Common Applications of Omentopexy

Omentopexy is a versatile technique used in various medical and surgical fields:

In Bariatric Surgery

Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure, but it carries a risk of complications like gastric leaks, bleeding from the staple line, and gastroesophageal reflux disease (GERD). Some surgeons perform an omentopexy alongside LSG, anchoring the newly formed gastric sleeve to the omentum. The goal is to:

Reduce gastric twisting (volvulus) that can cause functional stenosis.
Reinforce the staple line to lower the risk of bleeding and leaks.
Improve post-operative gastrointestinal symptoms like nausea and GERD.

However, the routine use of omentopexy in LSG remains a subject of debate, with some studies suggesting no additional benefit when other reinforcement methods, such as staple-line imbrication, are used.

For Peritoneal Dialysis Catheters

For patients with chronic kidney failure who require peritoneal dialysis (PD), a catheter is surgically inserted into the abdomen. A frequent complication is the obstruction of this catheter by the omentum, leading to catheter flow dysfunction. Prophylactic (preventative) laparoscopic omentopexy can be performed during catheter insertion to fix the omentum away from the catheter tip, significantly reducing this risk.

In Other Surgical Contexts

Duodenal Ulcer Repair: An omentopexy can be used to patch a perforated duodenal ulcer, utilizing the omentum's natural healing properties to seal the defect.
Esophageal Surgery: When performing an esophagectomy with anastomosis, wrapping the omentum around the connection point can help prevent anastomotic leakage, a severe complication.
Spinal Cord Surgery: In some complex cases, a pedicled omental flap (an omentum graft still attached to its blood supply) is used in omentomyelopexy to treat spinal cord injuries, promoting healing and reducing infection.

Comparison of Omentopexy Techniques

The surgical approach for omentopexy can vary depending on the primary procedure being performed and the patient's condition. The following table highlights the key differences between common methods.


Feature	Laparoscopic Omentopexy	Open Omentopexy
Invasiveness	Minimally invasive, using small incisions and a laparoscope.	Open abdominal surgery, involving a larger incision.
Surgical Tools	Laparoscope, surgical tacks, or suture devices.	Standard surgical tools and sutures.
Recovery Time	Generally shorter hospital stay and recovery time.	Longer hospital stay and overall recovery period.
Complications	Reduced risk of port-site complications like hernias.	May have a higher rate of complications associated with larger incisions.
Application	Common for peritoneal dialysis catheter placement and bariatric surgery.	Historically used in larger abdominal procedures or when laparoscopy isn't feasible.

The Omentopexy Procedure: A Step-by-Step Overview

While the exact steps depend on the specific surgical context, a typical laparoscopic omentopexy includes the following general stages:

Anesthesia: The patient is placed under general anesthesia.
Access: The surgeon makes one or more small incisions in the abdomen to insert a laparoscope (a thin, lighted tube with a camera) and other surgical instruments.
Visualization: The abdominal cavity is inflated with gas (pneumoperitoneum) to improve the surgeon's view of the organs.
Omentum Management: The surgeon assesses the omentum and frees it from any unwanted adhesions. The omentum is then repositioned or mobilized as needed for the procedure.
Fixation: The omentum is anchored to the target organ or the abdominal wall using sutures, clips, or a surgical tacking device. The goal is to secure the tissue in a desired position to prevent it from interfering with other structures.
Closure: Once the omentopexy is complete and the primary procedure is finished, the instruments are removed, the gas is released, and the incisions are closed.

Risks and Recovery

Recovery from an omentopexy is largely dictated by the primary surgery it accompanies. For a standalone, minimally invasive procedure, recovery is relatively quick. However, when combined with major surgery like a sleeve gastrectomy, the overall recovery time and potential for complications are higher.

Potential complications directly related to the omentopexy itself are generally low but can include:

Bleeding or hematoma formation at the fixation site.
Infection at the suture site.
Intestinal obstruction or twisting, though rare.
Issues specific to the primary procedure, such as staple line leakage in bariatric surgery.

Patients should follow their surgeon's specific post-operative instructions for diet, activity levels, and wound care. For procedures like laparoscopic sleeve gastrectomy, omentopexy has been shown to improve post-operative comfort and complication rates, but patients may still experience short-term gastrointestinal discomforts such as bloating or constipation.

Conclusion

An omentopexy procedure is a surgical technique that harnesses the natural properties of the omentum to provide structural support, enhance healing, and prevent complications in various surgical applications. From stabilizing organs during bariatric procedures to preventing catheter blockages in peritoneal dialysis, this procedure serves a crucial role in improving patient outcomes. While its specific application and efficacy can depend on the context of the primary surgery, it remains a valuable tool for surgeons to improve safety and mitigate risks. Patients considering any procedure that might involve an omentopexy should discuss the risks, benefits, and overall recovery plan with their surgeon.

For more information on different surgical techniques, visit the National Institutes of Health website.

Frequently Asked Questions

The primary goal of an omentopexy is to fix the omentum in a specific position to prevent complications or promote healing. This can include stabilizing an organ like the stomach, preventing a peritoneal dialysis catheter from being obstructed, or reinforcing a surgical staple line.

Yes, an omentopexy is almost always performed as a component of another procedure. For example, it is a common addition to laparoscopic sleeve gastrectomy or peritoneal dialysis catheter insertion to reduce the risk of certain complications.

A laparoscopic omentopexy is a minimally invasive procedure performed through small incisions, typically resulting in less pain, fewer complications, and a faster recovery. An open omentopexy requires a larger incision and is generally associated with a longer recovery period.

The risks are generally low but can include bleeding, infection at the surgical site, or the potential for short-term gastrointestinal discomforts like bloating or constipation, though these often improve over time.

Some studies have shown that adding omentopexy during sleeve gastrectomy can lower the rate of gastric leakage and other complications, though its benefit when combined with other reinforcement methods is still debated among surgeons.

The omentum is useful because of its rich blood supply and its natural ability to help with healing. It can aid in forming new blood vessels, seal off leaks, and contain inflammation, making it a valuable graft material in various surgeries.

Recovery is typically tied to the primary procedure being performed. After a minimally invasive omentopexy, recovery is quicker than with open surgery. Patients should follow their surgeon's specific guidance regarding activity restrictions and dietary progression.