Despite advances in many fields of surgery, incisional hernias still remain a significant problem. There is a lack of general consensus among surgeons regarding optimal treatment. A surgeon's approach is often based on tradition rather than clinical evidence. The surgeon's treatment plan should be comprehensive, with attention focused not merely on restoration of structural continuity. An understanding of the structural and functional anatomy of the abdominal wall and an appreciation of the importance of restoring dynamic function are necessary for the successful reconstruction of the abdominal wall. © 2008 Elsevier Inc. All rights reserved.