Abstract Background: The incidence of incisional hernia is high especially in high risk patients, it is more common after midline incisions than other incisions, wound closure techniques is an important factor in reduction of incisional hernia, small bite sutures, onlay mesh augmentation and sublay mesh augmentation of midline sutures helps reduction of midline incisional hernia. In this study we are trying to choose the optimum site of mesh placement for augmentation of midline sutures. Patients and methods: In this study we have two groups of high-risk patients undergoing abdominal surgery through midline incisions, Group I; 24 patients, the midline incision closure was reinforced by only polypropylene mesh. Group II; 23 patients, the midline incision closure was augmented by preperitoneal polypropylene mesh. Results: We recorded non-significant differences regarding the demographic data of patients, risk factors, ASA, and type of carried out surgery. The follow up time was 30.6±5 months in group I and 31.5±3.8 months in group II. In group I; we recorded 4 cases of seroma, 1 case deep wound infection this patient developed incisional hernia 2 months later, chronic pain in 4 patients resolved after 8 to 12 months, no hematoma or wound dehiscence In group II; we recorded no hematoma or chronic pain denoting a significant difference between groups, no incisional hernia, 2 cases of superficial wound infection, one case of hematoma and one case of wound dehiscence. Conclusion: The preperitoneal mesh position is superior to the onlay position with lower complications rate and lower incidence of incisional hernia.