This chapter is an exploration of crucial mesh fixation procedures within hernia repair. It delves into various techniques across different types of hernias, providing detailed insights into their application and significance. Firstly, it covers endoscopic inguinal hernia repair, where the focus is on mitigating risks associated with mesh fixation. It discusses the delicate balance required to secure the mesh effectively while minimizing potential complications such as chronic pain due to nerve injury. Techniques like the use of atraumatic fixation materials and precise placement strategies are emphasized to optimize outcomes, aligning with current HerniaSurge guidelines. Moving beyond inguinal hernias, the chapter extends its scope to encompass ventral and incisional hernia repair. Here, the emphasis shifts to the challenges posed by varying anatomical complexities and the critical role of mesh fixation in ensuring durable abdominal wall reconstruction. It explores modern techniques that leverage extraperitoneal mesh placement, highlighting advantages such as reduced access trauma and extensive mesh reinforcement. By addressing the nuances of mesh fixation across different hernia types and surgical approaches, the chapter aims to inform and guide the application of optimal surgical techniques in clinical practice.