A total of 74 patients, additionally treated with a pedicled omentoplasty, were studied retrospectively with regard to the complications. The pedicled omentoplasty was used extra- or intra-abdominally to reconstruct large soft-tissue defects, to treat radiation necrosis or to prevent radiation enteritis. Gastro-intestinal complaints were seen in six patients, three developed an ileus and needed a relaparotomy, one patient had herniation of the stomach through a diaphragm defect. Total necrosis of the omental flap was seen in two patients and infection in seven patients with an extra-abdominally used omentoplasty. An abscess in the pelvic cavity occurred five times in an intra-abdominally placed omentoplasty. In seven patients, an operative correction of an incisional hernia was necessary. One patient died of massive pulmonary embolism. This study indicates that the pedicled omentoplasty is a safe procedure and is associated with a moderate number of postoperative complications, which can be reduced if the right surgical technique is used.