The patient was on the operating table in supine position. General endotracheal anesthesia was induced. Foley was placed. The abdomen was shaved, prepped and draped in the standard fashion with a large almost basketball size hernia defect in the lower abdomen. The skin is marked. Esmarch were placed, so we would be able to do a reconstruction. It was marked for wide extensive lipectomy. Venodynes were positioned. General endotracheal anesthesia was induced. Time-out was performed. The abdominal lipectomy was performed and excised. This was submitted to pathology. We were then left with massive abdominal wall sac. These were excised on both sides. Abdomen was entered. There was an incarcerated complex hernia. A significant amount of the abdominal domain was gone. We were finally able to do extensive adhesiolysis and see the anesthesia record and then the viscera was returned into the abdominal proper. We then created our flaps rightward and leftward and then the component separation was performed. We were lateral to the rectus. External oblique was divided for the full length of this basketball size reconstruct and this allowed medial advancement of our abdominal wall. We then took a piece Zen metrics 15 x 20. It was hydrated then we rounded the corners preemptively placed 0-Ethibond sutures. This was placed as an underlie several of the sutures that were sitting very peripherally had to be placed through stab incisions to full-thickness abdominal wall. The other ones were placed underneath the abdominal wall flaps. It was then circumferentially seated, secured, and was in place. We irrigated the abdomen. Hemostasis was complete. A 10-mm flat Jackson-Pratt were placed through separate stab incisions bilaterally underneath the abdominal wall flaps and the fascia was closed centrally with interrupted 0-Ethibond sutures and the abdominal wall was closed with multilayered 2-0 Vicryl using the Esmarch for concentric reconstruction 3-0 Vicryl and 3-0 Monocryl, subcuticular Dermabond. Drains were placed to bulb suction. The patient tolerated the procedure well