Emergency ventral hernia repairs often warrant urgent operative intervention and are often associated with a higher rate of surgical complications and recurrence compared to elective repairs. Surgical options as well as mesh options will vary depending on patient and hernia characteristics. Incarcerated hernias provide a unique challenge, and minimally invasive surgical (MIS) approaches can be safe and feasible in the correctly selected patients, even in the setting of strangulation. Management decisions as well as choice of technique need to be decided upon more quickly and often are based on intraoperative findings, patient factors, and surgeon skillset. Minimally invasive techniques continue to evolve for elective surgery, and it is important to be able to offer these techniques so patients can afford the same benefits of MIS even in the urgent or emergent setting. This chapter will highlight both the management and technical best practices for emergent ventral and incisional hernia repair.