Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2021; 13(11): 1497-1508
Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1497
Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review
Arif Atay, Osman Nuri Dilek
Arif Atay, Osman Nuri Dilek, Department of Surgery, İzmir Katip Celebi University School of Medicine, Atatürk Education and Research Hospital, İzmir 35150, Turkey
Author contributions: Atay A wrote the majority of the paper, collected the data; and Dilek ON performed analysis and interpretation of the data, critical revisions of the manuscript and coordinated the writing of the paper.
Conflict-of-interest statement: All authors declare that there are no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
PRISMA 2009 Checklist statement: The manuscript has been prepared and revised according to the PRISMA 2009 Checklist including the 27-item checklist and a four-phase flow diagram.
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Corresponding author: Osman Nuri Dilek, FACS, Professor, Department of Surgery, İzmir Katip Celebi University School of Medicine, Atatürk Education and Research Hospital, C Block, Flat: 3, Basin Sitesi, İzmir 35150, Turkey. osmannuridilek@gmail.com
Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: March 30, 2021
Revised: April 1, 2021
Accepted: September 2, 2021
Article in press: September 2, 2021
Published online: November 27, 2021
Processing time: 291 Days and 12.2 Hours
Abstract
BACKGROUND

The omentum is an organ that is easily sacrificed during abdominal surgery. The scope of omentectomy and whether a routine omentectomy should be performed are still unknown.

AIM

To review the literature in order to determine the physiological functions of the omentum and the roles it plays in pathological events in order to reveal the necessity for removal and preservation of the omentum.

METHODS

A clinical review of the English language literature based on the MEDLINE (PubMed) database was conducted using the keywords: “abdomen”, “gastrointestinal”, “tumor”, “inflammation”, “omental flap”, “metastasis”, “omentum”, and “omentectomy”. In addition, reports were also identified by systematically reviewing all references in retrieved papers.

RESULTS

The omentum functions as a natural barrier in areas where pathological processes occur in the abdominal cavity. The omentum limits and controls inflammatory and infectious pathologies that occur in the abdomen. It also aids in treatment due to its cellular functions including lymphatic drainage and phagocytosis. It shows similar behavior in tumors, but it cannot cope with increasing tumor burden. The stage of the disease changes due to the tumor mass it tries to control. Therefore, it is considered an indicator of poor prognosis. Due to this feature, the omentum is one of the first organs to be sacrificed during surgical procedures. However, there are many unknowns regarding the role and efficacy of the omentum in cancer.

CONCLUSION

The omentum is a unique organ that limits and controls inflammatory processes, foreign masses, and lesions that develop in the abdominal cavity. Omental flaps can be used in all anatomical areas, including the thorax, abdomen, pelvis, and extremities. The omentum is an organ that deserves the title of the abdominal policeman. It is generally accepted that the omentum should be removed in cases where there is tumor invasion. However, the positive or negative contribution of omental resection in the treatment of abdominal pathologies should be questioned.

Keywords: Abdomen; Inflammation; Stomach; Omentectomy; Omentum; Tumor

Core Tip: The omentum is a unique organ that monitors and controls inflammatory processes, foreign masses, and lesions that develop in the abdominal cavity. Omental flaps can be used in all anatomical areas, including the thorax, abdomen, pelvis, and extremities. The omentum is an organ that deserves the title of the abdominal policeman. It is generally accepted that the omentum should be removed in cases where there is tumor invasion. However, the positive or negative contribution of omental resection in the treatment of abdominal pathologies should be questioned.