Purpose <p> Incisional and ventral hernia pose a complex surgical challenge with no consensus on the most appropriate repair technique. This study aimed to compare the short-term and long-term outcomes following open and minimally invasive techniques of incisional and ventral hernia repair.</p> Methods <p> Electronic search was conducted in PubMed, Scopus, Embase, Web of Science, LILACS and Cochrane CENTRAL databases, and Google Scholar, last date of search being 1^st January, 2025, to identify randomized trials comparing any two techniques of incisional and ventral hernia repair in adults, based on clinical outcomes such as recurrence, intraoperative and postoperative complications, or patient-reported outcomes. Risk of bias was assessed using Cochrane RoB2 tool. Statistical analysis was done using MetaInsight v6.0.1 and Stata version 16, using a random-effects model.</p> Results <p> Overall, 3229 articles were retrieved, of which 45 full texts were screened. Finally, 28 eligible studies, involving 3,162 patients were analysed. High risk of bias was observed in majority of studies. The primary outcomes of recurrence, and quality of life (QoL) were comparable across different techniques. Operative time was significantly longer in the robotic technique while length of hospital stay was significantly longer for the open technique. There were no significant differences in terms of intraoperative or postoperative complications. GRADE approach revealed quality of evidence to be low to moderate.</p> Conclusions <p> All open and minimally invasive techniques are essentially comparable in terms of short-term and long-term outcomes. An individualized approach can thus be expected to render excellent outcomes following any repair technique. </p>