Subcostal hernias are often grouped under the category of sub­xiphoid hernias; however, they are unique in the fact they tend to occur following previous incisions that follow the trajectory of the costal margin (Kocher incision, bisubcostal incision for liver transplant or bariatric procedure) and are in some ways more akin to flank hernias. Subcostal incisions typically sec­tion muscle fibers of the rectus abdominis and oblique mus­cles which creates a hernia incidence rate of 6–17 % [1]. Open repair requires mesh placement in the retromuscular or pre­peritoneal space with as much overlap with the rib as is pos­sible. When these hernias are large, we prefer an open approach utilizing a retromuscular approach with transversus abdominis release; however, this operation is extremely chal­lenging in the setting of a subcostal incision [18]. For this rea­son, the laparoscopic approach is utilized by many surgeons. Wassenaar et al. reported a recurrence rate of 1.7 % with a laparoscopic approach utilizing intraperitoneal mesh ade­quately covering the margins of the hernia [19]. Regardless of the approach, subcostal hernia repair is technically difficult due to the hernias proximity to bony structures; however, sim­ilar requirements of adequate mesh overlap and fixation remain paramount. As with subcostal defects, we prefer to not fixate the mesh above the ribcage (with tacks or sutures) due to the risk of intercostal nerve or lung injury and prefer the use of tissue sealants to fixate the mesh above the ribcage. Complete primary defect closure is often not possible.