A number of techniques are available to facilitate closure of the abdominal wall at ventral and incisional hernia repair. The ‘Peritoneal sac method’ makes use of the hernia sac to aid the reconstruction of the abdominal wall. This allows adequate repair of the posterior and the anterior layers of the abdominal wall, allowing a mesh with good overlap sandwiched between these layers, keeping the mesh away from the intra-abdominal contents and the subcutaneous space. This technique nearly always avoids the need for component separation, accepting a mild degree of ‘divarication’ but avoiding ‘bridging’. It appears to have good long-term outcomes, although like all techniques, obesity remains the major risk factor for recurrence and complications.