Giant Ventral Hernia repair of massive hernia by serial excision of gore-tex mesh is another choice [18]. Although this technique provides ana- tomic closure by medialization of the rectus muscle, it needs multiple operations over several weeks. Prosthetic mesh is widely used in the repair of ven- tral hernias. The use of sheets of non-absorbable mesh has revolutionized the repair of abdominal wall defects and ren- dered obsolete most of other older types of operations [10, 19]. Mesh repair of the ventral hernia have superiority over suture repair with regards to the recurrence [20]. Polypropyl- ene is most commonly used because it is easy to handle and relatively low in cost. Because polypropylene causes a pro- nounced inflammatory reaction, the mesh is well incorporat- ed in the surrounding tissue of the abdominal wall. However, for the same reason, polypropylene causes a strong stimulus for the formation of adhesions [21-23]. Many physical barriers are used in closure of large abdominal defects to prevent contact of the non-absorbable mesh with bowel including the use of absorbable mesh as a screen or double mesh. However, it now appears that the ab- sorbable mesh does not have any special characteristic as far as fewer adhesions and fistulae are concerned [10, 24-26]. Other materials that act as a protective layer on the visceral side of the non-absorbable mesh have been introduced in sur- gery. The aim is to provide sufficient separation between the mesh and viscera while regeneration takes place. The use of anti-adhesive liquids as Sepracoat and Icodextrin solutions are investigated. Coating the polypropylene mesh with se- prafilm or collagen or the use of physical barriers as human amniotic membrane are also studied [21, 27-30]. However, the use of coatings or foreign physical barriers may increase the rate of mesh infection [28, 30]. The possible complications when mesh comes into con- tact with the bowel include adhesions, chronic pain, bowel obstruction, and erosion into the bowel with enterocutaneous fistula formation [10]. None of these complications were ex- perienced in this study. The contact between the bowel and the prosthesis was prevented by interposition a natural bar- rier. This barrier composed of the hernia sac and the greater omentum, both shield the bowel from contact with non-ab- sorbable mesh. Careful Preoperative preparation by low resi- due diet, liquid diet, and colonic lavage is an important aid because it deflates the bowel. Aqueous sodium phosphate is a hyperosmotic solution draws plasma water into the bowel lumen to promote colonic cleansing. The ideal preparation would reliably empty the colon of fecal material, not cause any patient discomfort or harm and would be inexpensive [31]. To provide a larger abdominal cavity, no attempt to close the musculoaponeurotic defect was done. Therefore, the hernia contents can be replaced without tension and without compromising respiratory or cardiac functions. No patient required ventilation or suffered from compartment syndrome after operation in this series. The data in this study J Clin Med Res • 2009;1(4):226-229 demonstrate low complications rate with the use polypropyl- ene mesh and host tissue barrier in the repair of giant her- nias. Small asymptomatic hernia recurrence occurred in one patient (2.8%). No significant infection, mesh exposure or fistulae were experienced. There was no need to remove any of meshes. In conclusion, careful preoperative preparation, opera- tive technique, and postoperative care are required for suc- cessful management of giant ventral hernias. The use of polypropylene and host tissue barrier is relatively simple, safe, and reliable surgical solution to the problem of giant ventral hernia and avoids extensive, staged, or costly opera- tions. References 1. Javid PJ, Brooks DC: Hernias. 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