Omemtum removal for better PD draining

My husband is a PD patient and has very slow drainage towards the end of his exchange. It would seem that his Omentum is impeding the drainage of the fluid at the lower part of his abdomen. The nephrologist is recommending partial removal of the Omentum to help with this. Any advice/comments would be appreciated. This seems to be the last chance to stay on PD for my husband. He does not want to do HD.

Hi JC,

I was hoping a nurse might pop in and answer this for you, and maybe one will (we’ll try to ask). In the meantime, I did a bit of research for you on PubMed, the published scientific literature, and on-line.

The omentum, per one of the websites I visited, is, “The great omentum is a thin membranous bag, quilted as it were into little pockets which are filled with fat; the whole suspended from the stomach and the transverse colon, and overhanging the intestines like an apron. A smaller and more delicate omentum is stretched between the stomach and the liver.”

In the early 1980s, when PD first started, some centers routinely removed all or part of the omentum whenever they placed a PD catheter. It couldn’t always be removed; in some cases it would adhere to the abdominal wall (if there were adhesions from earlier surgeries for example), and sometimes it was too small or short to bother with. When they did routinely remove it, it did tend to cut down on catheter obstruction problems.

One study, for example, looked at “omentectomy” in 113 patients, compared to other patients for whom it wasn’t done. The researchers found significantly longer catheter survival in patients who did have the surgery. (p=.0002). This study was Nicholson ML, Burton PR, Donnelly PK, Veitch PS, Walls J. The role of omentectomy in continuous ambulatory peritoneal dialysis. Perit Dial Int. 1991;11(4):330-2.

More recently, in 2003, researchers found that removing the omentum in “selected patients” during laparoscopic PD catheter placement reduced the rate of catheter obstruction to 0.7%, compared to 12.8% for standard practice. This study was Crabtree JH, Fishman A. Selective performance of prophylactic omentopexy during laparoscopic implantation of peritoneal dialysis catheters. Surg Laparosc Endosc Percutan Tech. 2003 Jun;13(3):180-4.

We’re not doctors, but it seems like removing the omentum might be a good approach to helping your husband keep doing PD–especially since his doctor, who has examined him, believes it will.

Good luck!