Mesh repair is a generally accepted treatment for both inguinal, ventral and incisional hernia repairs. On the other hand, no consensus has been reached on which mesh fixation technique is superior. Depending on the type of procedure, surgical technique, mesh location and hernia and patient characteristics, the surgeon needs to choose from several options in his toolbox. Permanent tack fixation has proven to be strong, but several reports have been published showing increased postoperative and chronic pain, erosion and migration of tacks as well as fistulization. Absorbable fixation will probably limit these long-term side effects but not so much the acute postoperative pain. In contrast, non-penetrating fixation using glue or self-fixating meshes can do the job in retromuscular or preperitoneal space. This chapter will give an overview of the available options for different operative techniques and various locations of the mesh, as well as our own use of mesh fixation based on the currently available evidence and own experience.