Purpose This retrospective comparative study analyzes the outcome of patients affected by incisional hernia in potentially contaminated or contaminated field, treated by three operative techniques. Methods 152 patients (62 M:90 F; mean age 65 ± 14 years) underwent incisional hernia repair (January 2002–January 2012) in complicated settings. Criteria of inclusion in the study were represented by the following causes of admission: mesh rejection/infection, obstruction without gangrene but with possible peritoneal bacterial translocation, obstruction with gangrene, enterocutaneous fistula or simultaneous presence of ileo- or colostomy. The patients were divided into three groups: A ( n  = 76), treated with primary closure technique; B and C ( n  = 38 each), with reinforcement by synthetic or pericardium bovine mesh (Tutomesh ® ), respectively. The prosthetic groups were divided into Onlay and Sublay subgroups. Results Significant decreases in C vs A were observed for wound infection (3 vs 37 %) and recurrence (0 vs 14 %), and in C vs B for wound infection (3 vs 53 %), seroma (0 vs 34 %) and recurrence (0 vs 16 %). Patients with concomitant bowel resection (BR) (43 %) showed (all P  < 0.05) an increase of overall morbidity (55 vs 33 %) and wound infection rate (42 vs 24 %) compared to cases without BR. Morbidity presented no significant differences in C-Onlay or Sublay subgroups. B-Sublay subgroup has (all P  < 0.05) lower overall morbidity (20 vs 75 %), wound infection (10 vs 68 %) and seroma (0 vs 46 %) than B-Onlay. Conclusions The pericardium bovine patch seems to be safe and effective to successfully repair ventral hernia in potentially contaminated operative fields, especially in association with bowel resection.