Laparoscopic repair of incisional hernias shows advantages but comes with serious risks.

• No significant difference in recurrence rates between laparoscopic and open repairs.
• Laparoscopic approach lowers wound drainage risks (RR = 0.07) and postoperative infections (RR = 0.31).
• However, it nearly triples the risk of bowel injury (RR = 2.80).

Surgeons must weigh benefits against risks for optimal patient selection and outcomes.