A ventral hernia is an abnormal protrusion of an organ or tissue through a defect in the anterior abdominal wall. Such defects may occur spontaneously or arise due to a weakened abdominal wall musculature or due to previous surgical incisions. Despite being a common surgical condition, ventral hernias can prove to be a complex clinical entity, especially due to the myriad of techniques available for their repair. A common crucial denominator in all these procedures is the meticulous identification, handling and preservation of the neurovascular bundle. It is imperative to have a thorough understanding of the anatomy of the abdominal wall including it’s fascia, musculature and neurovascular structures, in order to ensure good clinical outcomes and prevent further complications. This chapter shall explore the detailed anatomy of the neurovascular bundle, it’s clinical significance and role in ventral hernia repairs and strategies to avoid damage to the neurovascular bundle and further complications.