[The labyrinth of composite prostheses in ventral hernias]

Reinforcement or replacement are increasingly being used in the repair of incisional hernias. In many occasions it is necessary to place the prosthesis in the intraperitoneal plane, for which the so called "composite" or bilaminar prostheses have been designed. A terminological precision is made in this article, defending the denomination of dual or "composite" prosthesis for these materials, and the different commercial available options at present are related. The numerous suitable alternatives on the market can do that the surgeon is in a labyrinth. A review of the experimental and clinical studies that support their use, efficiency, safety and complications is included. It concludes by recommending the prostheses for which there is consistent documentary evidence: Bard Composix, Dual Mesh, Parietex Composite, Parietene Composite and Proceed. However, longer term studies and randomised clinical trials are needed to make stronger recommendations.