A significant challenge in incisional hernia repair is the recurrence risk, which may be influenced by the structural integrity of collagen within the tissue. This study investigated the role of collagen metabolism in hernia recurrence by comparing oncologic and non-oncologic patients, focusing on collagen I/III ratios and their impact on tissue strength and surgical outcomes. A comparative clinical study was conducted on 50 patients (30 oncologic, 20 non-oncologic) undergoing incisional hernia repair. Collagen composition was analyzed using stereomicroscopy, and statistical comparisons were performed using independent t-tests and chi-square tests to assess differences in recurrence rates and tissue properties between groups. Results indicated that oncologic patients had significantly lower collagen I/III ratios (P < 0.001), suggesting structurally weaker tissue, which correlated with higher recurrence rates (18% in oncologic vs. 10% in non-oncologic patients). Furthermore, the sublay mesh repair technique demonstrated superior outcomes with lower recurrence rates compared to onlay repair, reinforcing its role in mitigating complications associated with poor collagen integrity. The study results indicated that oncologic patients had impaired collagen remodeling, contributing to an increased risk of recurrence. Individualized surgical strategies, including targeted preoperative interventions, may help mitigate these risks and enhance patient outcomes. Given the observed disparities, further research is warranted to explore targeted therapeutic approaches that enhance tissue quality and improve long-term surgical success in high-risk patient populations.