Abdominal hernia repair is the commonest operation in general surgery. The repair rate ranges from 10 per 100000 population in the United Kingdom to 28 per 100000 in the United States.1, 2 More than one million hernia repairs are performed each year in the U.S. No published hernia repair rate is available for South Africa. Abdominal wall hernias include inguinal, incisional, ventral and femoral hernias. The prevalence is also very high. It is 1.7% for all ages, rising to 4% for those over 45 years. Inguinal hernias account for 75% of all abdominal wall hernias, presenting a lifetime risk of 27% in men and 3% in women. Incisional hernias will develop in 10 to 15 percent of patients who have abdominal incisions, increasing to 23% in those who develop postoperative wound infection.3,4,5 The terrain of hernia surgery has changed significantly over the last decade. This has included new and evolving operative techniques, increase in the types of mesh and fixation devices used and advances in abdominal wall imaging. This period has also seen a significant increase in hernia related publications and a drive to evidence based medicine. This has resulted in an insurmountable amount of evidence and management that is protocol driven rather than patient centered. The success of real evidence based medicine allows for individualized evidence and expert judgment, relies on local feasibility, and requires all stakeholders to work together. In the absence of local data and leadership there has been attempts to adopt European or American guidelines with little success and much frustration. Currently there is no gold-standard operative technique for abdominal wall hernia repair.