Loss of domain incisional hernias is a real surgical challenge. The combination of a good preoperative strategy (preoperative neumoperitoneum) and surgical technique (TAR and dermolipectomy) may solve very complex cases of incisional hernia. We present a 72 years old obese frail woman operated of morbid obesity. Three years later was operated by anterior component separation technique. A recurrent incisional hernia developed and two episodes of intestinal obstruction were solved conservatively. An elective surgical repair was offered. A neumoperitoneum was scheduled 10 days before. An incisional hernia of almost the entire anterior abdomen was found under the previous onlay mesh. A bilateral TAR was made. The abdominal viscera were reintroduced in the abdomen after the release of intense adhesions to the colon. The posterior layer of peritoneum and posterior rectus sheath were closed. Absorbable mesh was used as reinforcement of posterior layer and support the "taco" configuration of a big 50 x 50 cm polypropylene mesh fixed inferiorly to both Cooper ligaments and superiorly with transparietal stitches. No lateral fixation was made. A great bridge in the midline was left but covered with the previous onlay mesh. A panniculectomy was also added.The patient was discharged on the 20^th postoperative day. A small anterior seroma was successfully treated with simple aspiration in an outpatient basis.In complex huge incisional hernias, a right preoperative policy, posterior components separation and panniculectomy are appropriate methods to achieve a complete reconstruction of the abdominal wall.