Background: Hernia is a very common surgical condition affecting all ages and both sexes. To describe and find the possible differences in the spectrum of abdominal hernias and document trends in their management, we carried out a descriptive study of all patients with abdominal hernias admitted to a single tertiary institution during a five years period. Methods: A descriptive study of all abdominal wall hernia repairs from Jan. 2002 to Jan. 2007. Data collection was done using patients’ medical records that were included in the hospital archives. Variables included age, sex, final diagnosis and type of repair. Results: 2516 hernia repairs were done. Inguinal hernias were the most common (56%), followed by adult umbilical hernia (22.7%), incisional hernia (10.3%), and epigastric hernia (7.4%). There is an increasing trend towards the use of synthetic mesh repair in different hernia varieties. Mesh repair in adult umbilical and incisional hernias has increased from 32 and 34.6% in 2002 to 63.8% and 90.7% in 2006 respectively. Conclusion: We have a higher relative frequency of adult umbilical and epigastric hernia in Upper Egypt. There is a change in the pattern of hernia repairs with increasing trend towards mesh repair in different varieties.