Dear Dr Chai,

In non-obese patients, reflecting upwards the omentum and entering in the correct “bursectomy” plane, helps in the subsequent D2 lymphadenectomy, because the plane of dissection continues as the same. In open surgery in obese patients this is also possible. However, when one operate on obese patients by laparoscopy the omentum does not fit over the liver, and it is easier to separate the dissection in to pieces.

Best regards

As long as a complete resection is performed, it doesn't matter and one might Taylor the procedure to his needs. 

Dear Chai

At our center we perform omentectomy also in laparoscopic gastrectomies. We prefer to perform this en block but there is no evidence this better than performing a seperate omentectomy. It can be a troublesome procedure which significantly adds to operating time in obese patients.

Best regards, Mark

Dear esteemed colleagues,

Thank you for your responses. They are very helpful. :)

The evidence for omentectomy is somewhat conflicting anyway. As a tule of thumb I believe you should strive to do the same operation laparosocpically as you would do open but I agree with Mark that this does not necessarily have to be en bloc.