The patient presented in the video case presentation is a young gentleman with a history of failed hernia repairs with a large midline hernia. The patient was evaluated and found to have a large recurrent defect, a low preoperative quality of life measured using HerQles, and was taken to surgery for abdominal hernia repair. The prior intra-peritoneal meshes were explanted, his retromuscular space developed, and bilateral transversus abdomens releases performed to close the posterior sheath. Pre-peritoneal mesh wash placed and glued using a fibrin. The patient did well after surgery, was hospitalized for 2 days, had no complications, and realized a significant improvement in quality of life.