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This paper outlines recent advances in the design, application, and operations and maintenance (O&M) of aerated treatment wetland systems as well as current research trends. We provide the first-ever comprehensive estimate of the number and geographical distribution of aerated treatment wetlands worldwide and review new developments in aerated wetland design and application. This paper also presents and discusses first-hand experiences and challenges with the O&M of full-scale aerated treatment wetland systems, which is an important aspect that is currently not well reported in the literature. Knowledge gaps and suggestions for future research on aerated treatment wetlands are provided.