OMENTUM IN ABDOMINAL SURGERY

Abstract

Background: The omentum is a versatile peritoneal organ with important roles in local immune surveillance, wound healing, angiogenesis, fat metabolism and in the dissemination and containment of intra‑abdominal disease. Objective: To synthesize current knowledge of omental anatomy, microanatomy, immunobiology, and pathophysiology and to examine its clinical relevance across surgical practice, including diagnostic considerations, operative management, reconstructive applications, oncologic implications and emerging regenerative uses. Methods: Narrative synthesis of anatomical, experimental, imaging and clinical literature addressing omental structure and function, common and rare omental pathologies, imaging features, operative strategies (including omentectomy and omental flaps) and translational research on omental-derived stromal cells and peritoneal immunity. Results: The omentum’s mesothelial surface, milky spots, resident macrophages and stromal cells mediate rapid peritoneal immune responses and promote localized containment of contamination, often limiting diffuse peritonitis. Its rich vascularity and trophic factor secretion underpin effective wound healing and make it an effective reconstructive flap. Pathologically, the omentum is implicated in infarction, torsion, abscess formation, sclerosing mesenteritis, primary tumours and peritoneal metastasis with characteristic “omental caking” on imaging. Omental adipocytes and stromal elements actively support tumour implantation and growth. Management principles emphasize preserving healthy omentum when beneficial, resecting necrotic or tumour involved tissue, employing image-guided drainage for abscesses and using cytoreductive omentectomy in selected malignancies (notably ovarian cancer). Emerging data support therapeutic potential of omentum-derived mesenchymal stromal cells and targeted strategies against omental tumour–stroma interactions, though randomized evidence for many surgical practices outside ovarian cancer remains limited. Conclusions: The omentum is central to peritoneal defence, healing, and tumour biology. Surgical decisions should be individualized to balance its protective and regenerative functions against its role as a niche for disease. Ongoing research into omental immunobiology and regenerative applications promises to refine indications for omentectomy, optimize reconstructive use and develop novel anti‑metastatic strategies.