Preoperative optimization plays a crucial role in successful hernia repair and minimizing complications, particularly in complex or recurrent cases. Addressing modifiable risk factors such as BMI, smoking, diabetes, and nutrition is essential. Patients with a BMI over 40 should strive to reduce their weight to below this threshold through lifestyle changes or consider bariatric surgery if needed. Smoking cessation is vital, ideally for eight weeks preoperatively, due to nicotine’s detrimental effects on wound healing. Optimizing blood glucose control, with a target HbA1c below 7%, is critical for individuals with diabetes. Ensuring adequate nutrition through dietary counseling or supplementation supports optimal wound healing. Emerging adjuncts like botulinum toxin A injections and progressive pneumoperitoneum can facilitate closure and reduce tension in complex repairs. Enhanced Recovery After Surgery (ERAS) protocols, encompassing preoperative risk factor management, multimodal pain control, and early mobilization, contribute to improved postoperative outcomes and reduced complications.