Subcostal bilateral incisional hernias are considered complex hernias according the actual abdominal wall hernias. We propose a posterior components separation technique performed through the previous incision to manage this kind of hernias. Methods: 40 years old male. Bariatric surgery in the year 2012 (BMI 57): laparoscopic vertical gastroplasty converted to open approach due to technical problems. Several complications took place during the postoperative period, including abdominal evisceration and partial resection of the upper anterior abdominal wall due to a severe necrotizing fasciitis. The patient was referred to our complex abdominal wall unit. His actual BMI is 40. He presents a loose of domain incisional hernia in the subcostal bilateral incision, with no possibility of reduction of the hernia sac content. Preoperative CT scan showed an abdominal wall defect of 20 x 20 cm in the upper abdomen, with absence of the upper part of both rectus abdominis muscles and left lateral abdominal musculature. Progressive pneumoperitoneum with the placement of a temporary intraperitoneal catheter was preoperatively performed. Abdominal wall reconstruction with a modified posterior component separation technique with overextended prerperitoneal 50 x 50 cm polypropylene mesh and a 20x30 cm synthetic absorbable mesh in the same space was performed. Results: The patient was discharged in the fifth postoperative day without any complications. After 14 months follow up, the patient is asymptomatic with no signs of recurrence. Conclusion: Posterior component separation technique performed through the previous incision is a feasible technique for the treatment of bilateral subcostal incisional hernia.