In a retrospective study on 245 patients we evaluated the results of 272 incisional hernia repairs in the Department Surgery of the University Hospital Aachen. The group consisted of 58% male and 42% female patients with a mean age of 61.1 years and 111 primary and 161 recurrent incisional hernias. Conventional techniques (simple closure, Mayo) and alloplastic repairs were performed in 69.9 and 30.1%, respectively. During the last 4 years we predominantly used the preperitoneal mesh repair with polypropylene mesh (Marlex). The results of 87% of our group of patients were evaluated by questionnaire and information from the family physicians (mean follow-up period 64 months). The patients who underwent preperitoneal mesh repair were examined clinically and with ultrasound. In comparison to the results of conventional hernia repair, early complications (seroma, hematoma) were higher. The recurrence rate, however, was significantly lower in this group with mesh repair (6.8%) than in patients without alloplastic augmentation (32.6%). Whereas preperitoneal mesh repair is convincingly the ideal surgical technique, optimization of the alloplastic materials by reduction of the amount of foreign substance and improvement of elasticity and biocompatibility is mandatory.