Incision hernia remains a frequent complication of abdominal surgeries with a reportedincidence of (2-20%). Repair of large incision hernia is a difficult surgical problem with short andlong term complications, severity of these complications are related in part to the type ofoperative technique adopted.The aim of this study is to evaluate the outcome of repair of large incision hernia with the (onlaytension free) mesh technique.This is a retrospective study includes 46 patients who underwent mesh repair for large incisionhernia during the period from January 1997 to December 2004. The operations were done bythe same surgeon and by the same procedure (i.e; onlay tension free polypropylene mesh withtwo points fixation). Data regarding relevant patients with big ventral incision hernia with (onlaymeshrepair) in Basrah teaching hospital and private hospital were revised. The presentingcondition, hernia description, associated systemic and local factors, procedure of repair andfollow up duration were all taken in consideration. Possible complications like; hematoma,seroma, wound infection, intestinal obstruction and enterocutaneous fistula were recorded anddiscussed once they occurred. The follow up period ranged from 4 to 21 months.Forty six patients were included in the study: 20 females and 26 males with median age of 50.5year (range 35-68 year). Eleven patients (23.91%) were overweight and had body mass index"BMI" equal to more than 30, four patients (8.69%) had controlled diabetes mellitus, five(10.86%) had controlled hypertension and two (4.34%) suffered from chronic obstructive air waydisease, there were eleven smokers (23.91%). Sixteen patients made regular visits thatextended up to 12 months, 12 patients made regular visits up to 6 months, one made regularvisits up to 18 month mainly due to partial intestinal obstruction., one patient was followed-up to17 month because of multiple wound sinuses while 8 patients made irregular visits up to 21month due to causes other than the hernia, eight patients lost from follow-up after 4 months.The original operation was bowel related in 18 cases, gynecological in twelve,hepatopancreatobiliary in 10, repair of paraumbalical hernia in six patients. The old incisionswere long midline in 23 cases, paramedian in 17 and transverse in six patients. The mainpostoperative complications were seroma formation (13.04 %), wound haematoma (6.52 %),wound infection (4.34 %). no recurrence of hernia and no enterocutanous fistula were reportedduring our follow-up period.In conclusion, tension free onlay mesh repair is a feasible operative procedure for repair of largeincision hernia with no significant major morbidity.