Despite the advent of and widespread application of MIS techniques, particularly in general surgery, incisional hernia remains a significant problem. This talk will briefly explore the factors associated with the development of incisional hernia (IH) after laparotomy and ways to reduce the risk of that. It will take an in depth look at the methods employed to close the abdomen and in particular the evidence for using “small bites” technique and mesh augmentation in selected high-risk patients. It will also look at pre and intraoperative strategies to mitigate against SSO/SSI.