Background <p>A variety of surgical techniques have been described for the open repair of lumbar incisional hernias. Determining the optimal surgical technique for these hernias remains challenging. This study evaluates the sandwich mesh technique, preperitoneal mesh, and onlay mesh for the treatment of lumbar incisional hernia.</p> Methods <p>This is a prospective study conducted to repair lumbar incisional hernias. We employed the sandwich approach with preperitoneal and onlay mesh reinforcement. Postoperative outcomes, complications, and length of hospital stay were assessed. The primary outcome was recurrence of hernia, and secondary outcomes included wound seroma, surgical site infection, and wound ischemia.</p> Results <p>Ten patients were involved in this study, six males and four females, with a mean age of 50.5 ± 9.32. The main complaints were abdominal protrusion at a site of previous abdominal operation, both in 100% of cases. Pain was present in four patients. All the patients had previous surgery through a lumbar incision; the most frequent surgery was for ureteric stone (7 patients), while the other cause was for nephrectomy (3 patients). 50% of patients presented with comorbidities, including diabetes mellitus, smoking habits, ischemic heart disease, and hypertension. The operative time was 76.4 ± 11.86&#xa0;min. The mean hospital stay was four days. Complications were infrequent and manageable, with seroma formation being the most common. No major morbidity was observed.</p> Conclusion <p>The sandwich mesh repair technique represents a potentially feasible surgical option for lumbar incisional hernia repair, demonstrating satisfactory early outcomes and acceptable complication rates.</p> Trial registration <p>NCT07196254.</p>