[The surface of the greater omentum in the human and its vulnerability in intra-abdominal surgical interventions]

From five patients of the Department of General Surgery of the University Hospital of Hamburg-Eppendorf, who underwent laparotomy because of different indications, small pieces of tissue of the greater omentum were taken intraoperatively. The surface morphology of the greater omentum was studied by means of light, transmission electron and scanning electron microscopy. It became obvious that intact tissue only was obtained when the procedure of taking out material was accomplished most carefully. Consequently, during normal surgical manipulations the greater omentum usually will be damaged. In undamaged tissue specimen the normal surface of the greater omentum in man is described. The findings basically confirm the results of previous investigations. Injuries at the surface of the greater omentum after surgical treatment are, however, much more severe than they are noticeable by the naked eye. Lifting up of the mesothelium, ruptures of the submesothelial structures of connective tissue, squashing of fat cells and ruptures of blood vessels can be observed. During these processes lipid droplets are squeezed into the submesothelial connective tissues or even pressed up to the surface of the mesothelium. Large quantities of erythrocytes are found in the interstitium in between the adipose cells. To what extent milky spots and free nerve endings at the surface of the greater omentum are damaged during intraoperative manipulations cannot be unequivocally estimated on the basis of the material studied here.