The greater omentum, a peritoneal fold derived from the dorsal mesentery, is critical in immune surveillance, inflammation regulation, and tissue repair. Its extensive vascular and lymphatic networks and immune-rich milky spots contribute to pathogen clearance, wound healing, and metabolic regulation. Despite its well-documented physiological roles, a comprehensive evaluation of its vascular and lymphatic architecture, embryological development, and clinical applications remains necessary to refine its use in pathology and surgical interventions. This review analyzes the greater omentum's structural organization, developmental origins, pathological involvement, and evolving role in surgical and therapeutic applications. A systematic review followed PRISMA guidelines, analyzing 69 studies from an initial pool of 2526 records. The review discusses the omentum's roles in immune defense and its involvement in pathological conditions such as torsion, cysts, and neoplasms. Its surgical applications, including omental transposition, anastomotic reinforcement, oncologic resections, and abdominal wall reconstruction, are explored in detail. Furthermore, the review examines its angiogenic and immunomodulatory properties, highlighting their contributions to reparative functions and potential clinical applications. The omentum's role in disease progression, particularly in malignancies, is also evaluated, emphasizing its dual function as both a protective barrier and a site for metastatic spread. By integrating anatomical insights with clinical relevance, this review strengthens the understanding of the omentum's diverse contributions to abdominal health and disease. Findings highlight its practical significance in surgical innovation and therapeutic interventions, offering new perspectives for future research into its regenerative potential, oncologic implications, and broader medical applications.