In this video, we will disscuss that Laparoscopic omental biopsy is a minimally invasive surgical procedure used to obtain tissue samples from the omentum, a layer of fatty tissue that covers and supports the intestines and organs in the lower abdomen. This procedure is commonly performed to diagnose conditions such as peritoneal carcinomatosis, tuberculosis, lymphoma, or unexplained ascites. In this article, we provide a comprehensive, step-by-step breakdown of the laparoscopic omental biopsy, from preparation to post-operative care.
 
 What Is the Omentum?
 
The omentum is a fatty apron-like structure that hangs down from the stomach and transverse colon. It plays a crucial role in immune response, fat storage, and infection containment. Because the omentum can be affected by various intra-abdominal diseases, obtaining a biopsy can help in diagnosing systemic and abdominal pathologies.
 
 Indications for Omental Biopsy
 
A laparoscopic omental biopsy may be indicated in the following situations:
 
- Suspected peritoneal malignancy or carcinomatosis
- Diagnosis of tuberculosis in cases of unexplained abdominal symptoms
- Evaluation of chronic ascites of unknown origin
- Staging of known intra-abdominal cancers (e.g., ovarian, gastric)
- Suspicion of lymphoma or other hematologic malignancies
 
 Pre-operative Preparation
 
Before surgery, the patient undergoes:
 
- Full clinical evaluation and imaging studies (Ultrasound, CT, MRI, or PET-CT)
- Routine pre-operative blood tests including CBC, coagulation profile, renal/liver function tests
- Informed consent explaining the procedure, risks, and recovery
- Fasting for at least 6-8 hours before surgery
- Administration of prophylactic antibiotics (if indicated)
 
 Surgical Technique: Step-by-Step
 
 1. Anesthesia and Patient Positioning
 
- The patient is placed under general anesthesia.
- They are positioned in a supine position, often with a slight Trendelenburg tilt (head down) to facilitate better visualization of the abdominal cavity.
 
 2. Port Placement
 
- A Veress needle or open (Hasson) technique is used to create pneumoperitoneum (insufflation of CO₂ gas).
- Typically, three ports are inserted:
- A 10-mm port at the umbilicus for the laparoscope.
- Two 5-mm accessory ports in the lower quadrants or flanks for instrumentation.
 
 3. Diagnostic Laparoscopy
 
- A thorough exploration of the abdominal cavity is performed.
- The surgeon inspects the peritoneum, liver surface, pelvis, and intestines for signs of disease.
 
 4. Identification of the Omentum
 
- The greater omentum is located and gently lifted.
- Areas that appear abnormal (e.g., thickened, nodular, discolored) are identified for targeted biopsy.
 
 5. Biopsy Technique
 
- Using laparoscopic scissors or energy devices (e.g., harmonic scalpel, bipolar), a portion of the omentum is carefully excised.
- Hemostasis is secured using clips, cautery, or sutures as needed.
- Sometimes, multiple samples are taken from different areas for a more accurate diagnosis.
 
 6. Specimen Retrieval
 
- The excised tissue is placed in a specimen retrieval bag and removed through the 10-mm port.
- Care is taken to avoid contaminating port sites if malignancy is suspected.
 
 7. Final Inspection and Closure
 
- A final check for bleeding or injury is done.
- Pneumoperitoneum is released.
- The ports are removed and the incisions are closed with absorbable sutures or skin glue.
 
 Post-operative Care
 
- Most patients can be discharged the same day or within 24 hours.
- Pain is usually minimal and managed with oral analgesics.
- Light activities can be resumed in a few days.
- Full recovery typically occurs within 7–10 days.
 
 Pathology and Follow-Up
 
- The biopsy specimen is sent for histopathology, and sometimes AFB (acid-fast bacilli) stain, GeneXpert, or culture if tuberculosis is suspected.
- Based on the results, further treatment such as chemotherapy, anti-tubercular therapy, or staging investigations may be planned.
- A follow-up appointment is scheduled to discuss pathology results and next steps.
 
 Advantages of Laparoscopic Omental Biopsy
 
- Minimally invasive with smaller incisions
- Less postoperative pain and faster recovery
- Better visualization of the abdominal cavity
- Higher diagnostic yield compared to blind peritoneal biopsies
 
 Risks and Complications
 
While generally safe, complications can include:
 
- Bleeding or hematoma
- Infection
- Injury to surrounding organs (rare)
- Port site hernia (rare)
 
With proper technique and patient selection, the procedure is both safe and effective.
 
Conclusion
 
Laparoscopic omental biopsy is a valuable diagnostic tool in modern surgical practice. It combines the benefits of minimally invasive surgery with the ability to obtain high-quality tissue samples for accurate diagnosis. This procedure is especially important in evaluating abdominal pathologies where imaging is inconclusive. When performed by experienced surgeons, it offers excellent outcomes with minimal complications.

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