Reperitonealization by omental graft

Reperitonealization by omental graft

In many instances the raw area on the pelvic floor and posterior uterine wall is so great following an extensive conservative operation for endometriosis that it is impossible to provide a peritoneal closure either by approximation of the peritoneal edges, a Baldy-Webster type suspension or by use of the sigmoid. If the sigmoid does not readily cover the defect, a free omental graft can be utilized to provide effective closure.

Reperitonealization

Figure 6. The omental graft is applied as a patch and is a free graft. It must, therefore, be detached from the main omental body. The surgeon and the assistant place the free edge of the omentum on tension. The individual vessels within the omentum are clamped with Kelly clamps. The tissue is divided and the clamps individually ligated.

by omental graft

Figure 7. The free omental graft is then sutured to the peritoneum of the posterior uterine wall and pelvic floor by interrupted catgut sutures.

Figure 8. The defect is now covered by the omental graft, thus preventing adhesion of small or large bowel to the area denuded of peritoneum.

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