The extended-view totally extraperitoneal (eTEP) approach has revolutionized ventral hernia repair by enabling a durable sublay mesh placement while minimizing intraperitoneal complications. However, in complex cases involving large defects, multiple prior surgeries, lateral hernias, or poor-quality soft tissues, a purely minimally invasive approach may be insufficient. This chapter explores the philosophy, rationale, and technical execution of hybrid repairs—combining the advantages of eTEP dissection with targeted open interventions. By navigating the interparietal anatomy extraperitoneally and judiciously employing open access for visceral adhesiolysis, fascial closure, or soft tissue revision, hybrid surgeries offer tailored solutions for complex abdominal wall reconstructions.