title: Mediastinal transposition of the omentum reduces infection severity and pharmacy cost for patients undergoing esophagectomy.
abstract: BACKGROUND
  The greater omentum has been found to be immunologically competent in protecting abdominal organs from inflammation. Anastomotic omentoplasty has been used and proven effective in preventing anastomotic leaks after an esophagectomy. However, pulmonary complications are still a substantial problem after an esophagectomy. This study investigated the benefits of mediastinal transposition of the omentum, a modification of the conventional omental wrapping technique, in controlling overall postoperative intrathoracic complications.
  
  
  METHODS
  From January 2010 to March 2015, 208 consecutive patients receiving an open Ivor-Lewis esophagectomy at our institution were retrospectively reviewed. One hundred twenty-one patients with omentum mediastinal transposition were assigned to the transposition group and 87 patients without omental transposition were placed in the non-transposition group. The patients' demographics, postoperative short-term outcomes, and in-hospital cost were documented and analyzed.
  
  
  RESULTS
  Mediastinal transposition of the omentum led to a shorter postoperative hospital stay (14 vs. 16 d, P=0.038) and a lower intrathoracic infection rate (30.6% vs. 48.3%, P=0.009). Intrathoracic infection was milder in the transposition group (P=0.005), though a non-significant was found in overall complications (P=0.071). The multivariate logistic regression analyses identified omentum mediastinal transposition (P=0.007, OR=0.415) as an independent protective factor for postoperative intrathoracic infection. The total in-hospital cost was comparable in both groups (P>0.05), whereas the pharmacy cost was lower in the transposition group than in the non-transposition group (¥21,668 vs. ¥27,012, P=0.010).
  
  
  CONCLUSIONS
  Mediastinal transposition of the omentum decreases the rate and severity of postoperative intrathoracic infection following an open Ivor-Lewis esophagectomy. This result in decreased pharmacy costs, rather than resulting in an increased economic burden sustained by surgical patients.
authors: Department of Thoracic Surgery, The first Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors: Peng
authors: P
authors: Ye
authors: Department of Thoracic Surgery, The first Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors: Jin-Lin
authors: JL
authors: Cao
authors: Department of Thoracic Surgery, The first Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors: Qiu-Yuan
authors: QY
authors: Li
authors: Department of Thoracic Surgery, The first Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors: Zhi-Tian
authors: ZT
authors: Wang
authors: Department of Thoracic Surgery, The first Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors: Yun-Hai
authors: YH
authors: Yang
authors: Department of Thoracic Surgery, The first Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors: Wang
authors: W
authors: Lv
authors: Department of Thoracic Surgery, The first Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
authors: Jian
authors: J
authors: Hu
keywords: Omentum; cost; esophageal cancer; infection control; postoperative complications