Laparoscopic repair of incisional hernia has been shown safe and efficacious, with low rates of conversion to open, short hospital stay, moderate complication rate, and low recurrence. Using the benefits of open retromuscular, sublay repair, the laparoscopic approach provides adequate mesh overlap and allows for identification of the entire abdominal wall fascia at risk for hernia formation. Fixation of the prosthesis to the abdominal wall is best provided by transabdominal to secure the mesh during the initial phase of incorporation. Long-term follow-up data support the durability of laparoscopic repair of ventral hernias with reduced rate of recurrence, low risk of infection, and applicability to difficult patient populations, such as the morbidly obese and those with prior failed attempts.