Background: Ventral hernias are defined as a defect of the fascia in the anterior abdominal wall with or without a bulge. Clinical presentation varies from small incidental defects to giant and complicated hernias with fistulas and viscera located outside the abdominal cavity covered only by peritoneum and skin. It includes incisional hernias, paraumbilical hernias, umbilical hernia, epigastric hernias, and spigelian hernias, respectively. Objective: The aim of the present study was to evaluate the functional outcome of pre-peritoneal mesh repair in management of ventral hernia. Patients and methods: This was a case control study of incisional hernia repair by pre-peritoneal mesh implantation that was carried out on 40 subjects collected consecutively at Kafr El-Sheikh General Hospital and Sayed Galal University Hospital. Diagnosis was based on clinical criteria. Results: Regarding to symptoms, 34 cases showed swelling (85%), only 5 cases had swelling and pain (12.5%) and a case showed swelling, pain, and vomiting (2.5%). Chest infection was the most common complication seen with 3 cases (7.5%), wound infection and persistent pyrexia were seen in 2 cases for each (5%) and cellulitis, seroma and post-operative ileus were seen in only one case for each (2.5%). Conclusion: follow up findings showed no complications except recurrence in only one case. Therefore our study affirms that pre-peritoneal mesh repair or sublay mesh is the ideal repair technique and highly recommended for ventral hernia.