Despite having a cohort of hernia surgeons in Australia with deserved international reputations, there are still many issues relating to hernia repair outcomes: patients with chronic pain; wound and mesh infections; fistulae; botched AWR’s; unknown rates of ventral and inguinal hernia recurrence; and neglected abdominal wall disasters. In an era of increasing complexity of abdominal wall surgery, more legislation and increased litigation; the current situation provides several clinical challenges starting with getting hernia repair right the first time, preventing complications, reducing hernia recurrence and managing complex abdominal wall problems. These problems have arisen for multiple reasons. Inappropriate patient selection, inadequate patient optimization and poor choice of operative approach, combined with poor execution, failure to recognize and manage complications, and insufficient follow up. The result of a lack of training in the basics, inconsistent application of “best practice”, wide variation and misuse of advanced techniques and technology, lack of access to “specialists” (or perhaps a reluctance to refer?) and an inability to recognize and reluctance to refer complex cases till too late. Additionally, there are problems resulting from the lack of a national hernia/mesh implant registry, poor MBS remuneration and the safe integration of new technology and mesh. The solution lies in education, including changes to GSET and the set-up of a post fellowship hernia program based in accredited centres of excellence. Most importantly, individual surgeons need to accept responsibility and have the insight to remain within their level of competence.