Preoperative progressive pneumoperitoneum is a well-known, but sporadically used procedure in preparing patients with giant inguinal or incisional hernias for the operation. The technique requires frequent insufflation of air into the abdominal cavity in order to create space to accommodate herniated viscera and facilitate fascial repair with minimal tension. This article demonstrates the histological findings, technique, complications, advantages and long-term results of the preoperative progressive pneumoperitoneum in hernia repair.