Endoscopic harvest of the omental and jejunal free flaps.

Experimental and clinical cases document that the omentum and jejunum can be harvested successfully as a free flap using laparoscopic assistance. Our gross and microscopic findings attest to the viability of this approach. If the omentum is not needed in it entirety, one can safely custom design the free flap to match the defect size, leaving only a small abdominal scar, as illustrated in the partial omentectomy case. The long, large vessels can simplify the microanastomosis in difficult situations and avoid the use of vein grafts. The abdominal incision required in most of our cases was minimal, with an inconspicuous donor site scar. The procedure has been well tolerated by the patients, and the postoperative course has been unremarkable. Although some modifications already have been presented to the original technique of laparoscopic jejunal and omental harvesting, more cases are necessary before one can reach definitive conclusions about whether the endoscopic approach is significantly better than the classical open technique.