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The best approach for lateral incisional hernia is not known. Posterior component separation (reverse TAR) offers the possibility of using the retromuscular space for medial extension of the challenging preperitoneal plane. The aim of our multicenter study was to compare the operative and patient-reported outcomes measures (PROMs) using two open surgical techniques from the lateral approach a totally preperitoneal vs a reverse TAR. A retrospective cohort study was performed since 2012 to 2020. Patients with lateral incisional hernia tre