Incisional hernias develop in 2% to 11% of patients who undergo laparotomy. Prosthetic mesh repair provides more strength, tension-free closure, and decreased recurrence rates as compared to primary tissue repairs. Complications-fistula formation, adhesions, skin erosion, and seroma/abscess formation-however, include increased rates of infection, sometimes requiring complete mesh removal. The Rives-Stoppa repair for complex incisional hernias confers the benefits of prosthetic repair and lower recurrence rates, but decreases certain complications by preventing direct mesh contact with the bowel. A total of 89 consecutive patients (mean age, 58.1) underwent a modified Rives-Stoppa repair for purposes of this review, all the patients who lost to follow-up before 6 months postoperatively were excluded from the study. Of the remaining 59 patients, 32.2% (n = 19) had expanded polytetrafluoroethylene mesh, and 67.8% (n = 40) had polypropylene mesh. Average range of follow-up was 40.0 months. Hernia recurred in 1 patient (1.7%). Infection requiring explantation of the prosthesis occurred in 3 patients (5.1%). The Rives-Stoppa repair is reportedly the best open technique for complex incisional hernias with comparatively lower recurrence rates. Additionally, patients with inflammatory bowel disease (64.4% of our series), who often require later reoperation for their primary disease, may benefit from this technique of herniorrhaphy where no interface exists between intrabdominal contents and the prosthesis. This lack of interface decreases intrabdominal adhesions and facilitates re-entry if future surgery is needed for inflammatory bowel disease.