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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 left gastroepiploic artery and the vasa recta along the greater curvature of the stomach with mobilization of the omentum from the transverse colon allows the development of a vascularized omental pedicle flap. The following is an account of the various ways by which the omentum can be...