OBJECTIVE To compare suture with mesh repair, for incisional hernia in terms of early and late outcomes. METHODS We reviewed the records of all the patients who presented with primary or recurrent incisional hernia in the Department of General Surgery, Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia, from January 2000 to December 2004. We divided patients, who underwent repair, in 2 groups: Group A (suture repair) and Group B (mesh repair). The information recorded for both groups included gender, age, associated systemic illness, site of hernia, initial surgery, number and type of previous hernia repairs, size of hernial defect, techniques of repair, and hospital stay. The principal early and late outcome measures studied were septic complications and recurrence. RESULTS A total of 123 patients qualified for the study, 72 in group A and 51 in group B. Wound infection was 5.5% in group A versus 3.9% in group B (p=0.51). Follow up ranged between 6-58 months (mean 37.5 months) for both groups. Fifteen patients (20.8%) developed recurrence in group A, while the recurrence rate in group B was only 5.8% (p=0.04). CONCLUSIONS Mesh repair resulted in a lower recurrence rate, and is not associated with increased incidence of wound complications compared with suture repair.