Hernia recurrences can be physically, mentally, and financially challenging for patients and can pose a conundrum for the most experienced abdominal wall surgeons. For years, it was believed that transfascial fixation (TF) would prevent mesh migration, decrease tension at the midline, and potentially lower the chance of repair failure. In this issue of JAMA Surgery, Ellis et al¹ investigate the role of TF in open ventral hernia repairs and report that patients without TF had similar rates of recurrence, pain, and quality of life at 1 year after operation as patients with TF, although with a higher risk of wound morbidity. Overall, the results suggest that TF may not be necessary during complex hernia repairs.