The recurrence rate for incisional hernias following reconstruction depends not only on the size of the initial hernia or abdominal wall defect but also on the number of the concomitant diseases. The surgical approach chosen and the level of tension affecting the sutures both represent essential indicators of long-term success in abdominal wall reconstruction. Several techniques have been advocated to reconstruct the abdominal wall, either with or without use of alloplastic material. A number of authors even recommended separating the lateral components of the abdominal wall to preserve innervation and blood supply of the advanced parts.This retrospective study is based on a patient collective consisting of 23 patients. In addition to hernias or abdominal wall defects, all of them suffered several concomitant diseases and were treated at the German university hospitals in Erlangen-Nürnberg and Freiburg. All procedures were performed between the years 2000 and 2006. In all cases, reconstruction of the abdominal wall was achieved by employing the separation of components technique by Ramirez. Some of these procedures entailed the use of alloplastic material. Use of this material was based on intraoperative tensiometry results. Surgical outcome was determined by evaluating postoperative complications and the hernia recurrence rate.We achieved complete anatomic reconstruction of the abdominal wall in 61% of cases. Alloplastic mesh was used in 39% of the cases. Results of a long-term follow-up (56 months) revealed that only 18% of patients experienced hernia recurrence.Intraoperative tensiometry provides an additional important parameter for the surgical algorithm. Depending on the results, the appropriate surgical method for each case can be chosen. The decision on whether this procedure entails the use of alloplastic mesh can also be based on intraoperative tensiometry results.