The Rives-Stoppa repair, or open retromuscular repair, originated in the 1960s when two surgeons, Jean Rives and Rene Stoppa, independently developed an extraperitoneal hernia repair technique. Since then, the technique has become the gold standard for an incisional hernia repair. The multiple advantages it offers are durability, superior long-term outcomes, and exclusion of mesh from the intraabdominal viscera. The extraperitoneal approach is beneficial as it minimally impacts future abdominal procedures. The retrorectus space is an easily dissected avascular space allowing relase of the rectus abdominis muscle from the posterior sheath facilitating fasical advancement in hernia defects up to 10cm in transverse dimension. This space also accommodates larger pieces of mesh that can be placed with a wide overlap, in most cases greater than the 5 cm overlap generally recommended. The anterior rectus sheath is then closed over the mesh, and the subcutaneous tissue is reapproximated in multiple layers to reduce dead space and seroma formation. This chapter will go over in-depth technical details of the procedure with illustrations, perioperative management, and common pitfalls.