Ventral hernias in the anterior abdominal wall include both spontaneous (e.g., umbilical, epigastric, and spigelian) and, most commonly, incisional hernias after an abdominal operation. Small ventral hernias less than 2½ cm in diameter are often successfully closed with primary tissue repairs. However, larger ones have a recurrence rate of up to 30 or 40 percent when a tissue repair alone is performed. It is estimated that 2 to 10 percent of all abdominal operations result in an incisional hernia. This explains the predominance of such hernias. Fortunately, the use of mesh has revolutionized the repair of abdominal wall hernias. Anterior placement of polypropylene mesh as an onlay to the primary repair is helpful and a retrorectus muscle placement is even better. However, the development of dual-sided mesh has allowed for an improved placement of mesh behind the abdominal wall and the hernial defect. These meshes present an intraperitoneal nonadherent surface (expanded polytetrafluoroethylene, or PTFE) to the bowel and an open polypropylene mesh grid or screen for adherence and incorporation into the peritoneum and posterior abdominal wall fascia. The dual-sided meshes can be placed laparoscopically for almost any ventral hernia, but extremely large hernias with loss of abdominal domain or those associated with extensive, dense intra-abdominal adhesions (e.g., peritoneal dialysis, prior peritonitis) are relative contraindications. The meshes are very expensive; however, operating room time and hospital length of stay are shortened. The laparoscopic incisions cause less pain and there is a faster return to normal activities or work. Finally, laparoscopic repair enables the detection and repair of multiple defects—a common finding in midline incisional hernias.