Purpose: Incisional hernia (IH) is a well-documented complication of open abdominal aortic aneurysm repair (OAR) with reported rates ranging from 13% to 46%. The long-term rate of IH affecting OAR patients remains poorly studied with few studies extending follow-up beyond five years. Given that OAR is typically recommended to younger patients who require a durable repair, long-term data is required to assist with accurate pre-operative counselling of patients. Methodology: All patients who underwent OAR at Auckland City Hospital between January 2004 and December 2008 were identified. Patients who did not survive 30 days post-operatively, who resided outside New Zealand and who had incomplete medical records were excluded. Electronic medical records were retrospectively reviewed to identify patients who developed IH after OAR. A multivariable cox regression analysis was performed to ascertain the effect of patient demographic, anthropometric, disease, and treatment variables on the likelihood of developing an IH after OAR. Results: Two-hundred and twenty-six patients were included in our study. Most patients were male (75.7%) and of European ethnicity (85.0%). Two-hundred and five (90.7%) patients were deceased at the time of analysis. The median follow-up amongst survivors was 18.2 years (Mean: 17.80 +/- 1.40 years). Forty-three patients (19%) developed an incisional hernia after OAR. Patients with a BMI≥30kg/m2 at the time of OAR and those who previously had a midline laparotomy were significantly more likely to develop an IH (HR 3.49 (1.82 - 6.69, p<0.001) and HR 2.52 (1.09-5.85, p=0.031)). Conclusion: The long-term rate of IHs in our OAR survivor population is lower than that described in other OAR patient cohorts but is comparable to the rate of IHs in general laparotomy cohorts. Most of our patients received life-long follow-up. This study provides results that enable the accurate counselling of patients considering OAR.