This video article demonstrates open repair of a 1-cm incarcerated epigastric hernia without mesh in an active elderly patient. An incision was made directly over the hernia, which contained a significant amount of lipomatous fat and an unexpected peritoneal sac. Following excision, the fascial defect—located within a rectus diastasis—was closed in two layers using permanent sutures: interrupted sutures followed by a running imbricating stitch. Subcutaneous and subdermal tissues were approximated for comfort and improved cosmesis. This case illustrates a simple, tension-free, cosmetically conscious repair technique suitable for small symptomatic epigastric hernias.