Introduction: Historically, hernias have presented a challenge to surgeons. Due to unsatisfying results, surgical repair of hernias has evolved from open technique to the laparoscopic approach.

Methods: Successful laparoscopic hernia repair can be achieved with adherence to these basic principles.

• Avoiding use of thermal or electrical energy when lysing adhesions that may involve bowel.
• Accurately identifying the fascial edges of a hernia defect.
• Clearing an adequate margin around the hernia for overlap of a bioprosthesis (mesh).
• Transfascial or bone fixation.

Results: Some hernias make adherence to these principles difficult. We present three challenging hernia cases: Recurrent Parastomal hernia, Flank Hernia, and Suprapubic hernia repairs. In all three cases, the preceding principles were followed in order to secure a successful hernia repair.

Conclusion: Complex hernias can be approached and repaired successfully as long as basic principles are followed. We have demonstrated avoidance of thermal or electrical energy; identification of fascial edges; clearing of fascia; and transfascial or bone fixation applied in three challenging cases with positive results.