Giant lumbar hernia, with loss of domain, is a complex scenario to treat. Abdominal compartment syndrome is a dreaded post-operative complication. This can gravely impair the patient's respiratory function and also cause insufficient perfusion of the viscera. Pre-operative progressive pneumoperitoneum can facilitate bowel repositioning and can reduce impairment of the post-surgery lung function, essential for a favourable post-operative outcome. Here, we describe the treatment of a case of giant lumbar incisional hernia by the creation of progressive pneumoperitoneum and hybrid repair of incisional hernia with left posterior component separation and placement of giant prosthetic reinforcement of the defect.