Ventral hernia surgery has evolved into the highly complex surgical specialty with challenging comorbid patients. In the first half of this chapter, the trends and developments of ventral hernia surgery in Europe over the last 100 years are outlined, and the important discoveries that have changed our surgical practice are highlighted. The second half describes the current practice of ventral hernia surgery, the use of innovative surgical techniques and multidisciplinary teams, the emergence of national specialist hernia centres, the use of negative pressure dressings and the development of national ventral hernia databases.