Byline: M. Alagumuthu, Bhupati. Das, Siba. Pattanayak, Mangual. Rasananda

In the past, the omentum was considered to be an inert tissue without much biological significance. But since the beginning of the last century, innumerable studies and trials have been conducted by surgeons and scientists all over the world, which have proven that the omentum is a unique, physiologically dynamic tissue with immense therapeutic potential. We have undertaken the present review to provide a concise account of the variety of applications of the omentum in the various disciplines of surgical practice. An extensive search was carried out on the internet for indexed publications in the English literature using the keywords "omentum, omentoplasty and surgical uses of omentum." The search revealed about 86 publications. All those publications were systematically reviewed and analyzed. The inferences derived from those publications are methodically summarized. The omentum is indeed an organ of exceptional versatility. This review presented by us will enable the readers to appreciate the fact that, clearly the omentum was placed in the abdomen for a reason.

The greater omentum is nothing but a large fold of peritoneum that hangs down from the greater curvature of the stomach like an apron to a variable extent over the intestinal loops. It appears as a thin fenestrated membrane with varying amount of fat deposition. Apart from serving as a storehouse of fat, it protects the peritoneal cavity from infections by virtue of its "milky spots," which are nothing but collections of macrophages. It is also said to limit the spread of intraperitoneal infections by moving to the concerned site and sealing it from the nearby area, a function that has made the British surgeon Rutherford Morrison to rightly name it as "The policeman of the abdomen" in the early 20th century. In spite of all these valuable functions, the omentum is often forgotten.

Special properties of the omentum

Certain special attributes of the omentum favor its innumerable applications in day-to-day surgical practice. Basically, it is a highly vascular organ with a rich source of angiogenic factors that promote the growth of blood vessels into whatever tissue it is placed close to. The potent lymphatic system of the omentum can absorb enormous amounts of edema fluids and remove metabolic wastes and toxic substances. Recent studies have revealed that the omentum, apart from being a great source of various growth factors, neurotransmitters, neurotrophic factors and inflammatory mediators, also contains omnipotent stem cells that can differentiate into a variety of cell types. It provides an excellent plastic material against inflammation and irradiation. Anatomically, the attachments of the omentum and the arrangement of the vascular arcades are in such a way that it can be lengthened to an unbelievable extent at a vascular pedicle, exteriorized or detached using microvascular techniques for various intra-abdominal and extra-abdominal procedures. The arterial and venous supply to the omentum are derived from the branches of the right and left gastroepiploic vessels that course along the greater curvature of the stomach. Division of the right or...