title: Laparoscopic harvesting of omental pedicle flap for cerebral revascularization in children with moyamoya disease.
abstract: BACKGROUND
  An abundance of angiogenic and immunologic factors makes the omentum an ideal tissue for reconstruction and revascularization of a variety of extraperitoneal wounds and defects. Omental harvesting was historically performed through a large laparotomy and subcutaneous tunneling to the site of disease. Several complications of the open procedure including abdominal wound infection, fascial dehiscence, ventral hernia, and postoperative ileus have been described. The use of laparoscopy to harvest the omentum has the potential to reduce such complications. We describe the surgical technique and 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
  A total of 7 children 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 patients were followed postoperatively with clinic visits and angiography. There was one intraoperative complication (colon injury) and one postoperative complication (intermittent omental hernia at fascial defect for pedicle). All patients had partial to complete symptomatic resolution and demonstrated adequate intracranial revascularization on angiography.
  
  
  CONCLUSIONS
  Laparoscopic omental pedicle flap mobilization and subcutaneous transposition is feasible in children who require salvage cerebral revascularization for moyamoya disease. The procedure should be considered for other conditions requiring extraperitoneal revascularization.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Matias
authors.initials: M
authors.lastname: Bruzoni
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Gary K
authors.initials: GK
authors.lastname: Steinberg
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA. Electronic address: sdutta@mac.com.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Dutta
mesh_terms: D000293:Adolescent; D000792:Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D009852:Omentum / Q000098:blood supply / Q000637:transplantation*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods*
keywords: Laparoscopy; Moyamoya disease; Omentum; Vascular pedicle flap