BACKGROUND: Retromuscular mesh reinforcement and posterior component separation techniques are increasingly being used in lateral and midline complex incisional hernias. The use of a bioabsorbable mesh in combination with a permanent mesh may help in difficult cases. MATERIAL AND METHODS: We present a case of a 65 years old man with medical history of chronic bronquitis and hypertension, with a long history of operations on the abdominal wall. Everything started with three failed umbilical hernia repairs with recurrences and infections. In 2009 had a lower anterior resection and closure of abdomen with mesh. Two more unsuccessful attempts of hernia repair were made. The last one with a biological mesh to bridge the repair. The patient was referred to our unit for definite repair of a hernia EHS M1-5, W3; VHWG III. A bilateral TAR was made. The combination of a bioabsorbable and permanent mesh implanted on the same retromuscular position was used. The absorbable mesh is made of polyglycolic acid and carbonate trimethylene and the polypropylene meshes selected was a 50 x 50 cm macroporous mesh with density of 48 g/m2 and minimum pore of 1,5 mm (medium density polypropylene). RESULTS: The patient was discharged uneventfully on the 7th postoperative day. The clinical results at 18 months showed a complete reconstruction of the abdominal wall. CONCLUSIONS: Bilateral TAR and the combination of absorbable and permanent mesh allows to achieve a complete abdominal wall reconstruction in complex cases.