The evolution of hernia and abdominal wall surgery is, in essence, a history of advancing anatomical cognition—progressing from macroscopic to microscopic perspectives and from vague impressions to precise understanding of abdominal wall structures. Traditional hernia repairs relied heavily on empirical techniques, which were often associated with high recurrence rates and significant complications. In contrast, the success of modern hernia surgery is firmly grounded in a profound comprehension of the fine anatomy of each abdominal wall layer, particularly the fasciae, muscles, nerves, vessels, and potential spaces. Individualized and precision-oriented surgical strategies based on the “anatomy-function-repair” philosophy are fundamental to reducing recurrence rates, minimizing postoperative chronic pain, and improving long-term quality of life. Looking ahead, with continued advancements in three-dimensional imaging reconstruction, artificial intelligence, and biomaterial science, research into the fine anatomy of the abdominal wall will continue to propel hernia and abdominal wall surgery toward higher levels of development.