Incisional hernia is a common complication to laparotomy impacting negatively on quality of life, risk of emergency surgery and cosmesis. The operation of giant incisional hernia (cross diameter of hernia defect > 20 cm) is a high risk procedure and the surgical techniques are not based on high level evidence. Mesh placement is possible onlay, inlay, sublay or intraperitoneal. These operations are most often performed as open procedures, or in combination with endoscopic techniques. These procedures should be centralized to few centers to improve quality and allow robust research.