The key to successful mesh repair of a hernia, is the integration of a mesh into tissues of the abdominal wall, which is able to resist the forces of everyday activities, and the repeated forces that happen many times a day without mesh/abdominal wall failure. Closure of the hernia defect or at least flattening of the hernia bulge is an important step. And then placing a mesh of sufficient size to effect a permanent repair. Mesh size is perhaps better considered as a mesh:defect area ratio rather than a more simple linear overlap measurement. And the properties of the mesh, and the ability of the patient to integrate the mesh into the tissues well (which includes individual scar tissue formation abilities as well as the quality of the prepared landing zone for the mesh) are important considerations.