Incisional hernia is the most common complication of laparotomy with an incidence of 2-20% [1-6]. In 2001, approximately 150000 abdominal procedures (laparotomy and laparoscopy) were carried out in The Netherlands (16 million inhabitants). Considering hernia rates from the literature, the number of 12 500 new incisional hernias should be expected annually. These numbers have a highly negative impact on the cost-effectiveness of surgery, and result in an unacceptably high frequency of co-morbidity. In addition, they have a significant impact on hospital capacity. To investigate to what extent the occurrence of incisional hernias is avoidable, we studied risk factors for incisional hernia and how the negative influence of these risk factors may be reduced or eliminated.