Incisional hernia repair without mesh mainly consists of tissue transfer to bridge or close the defect. Bridging includes rotational or free musculocutaneous flaps, rendering acceptable short-term results but a rather disappointing long-term outcome. Abdominal wall closure where there has been significant loss of domain, with intraperitoneal organs residing permanently outside the abdominal cavity, can only be achieved using the patients' own tissue if preoperative expansion of the abdominal cavity is performed using artificial expanders or pneumoperitoneum. From a scientific point of view, however, evidence supporting any treatment option is weak because prospective randomized controlled trials are virtually impossible to conduct owing to the inhomogeneity of the patient population being considered. Treatment of this condition by the above-mentioned means should therefore be proposed on an individual basis utilizing one or more of the many possible techniques described.