Purpose <p>Spigelian hernias (SHs) occur through the Spigelian fascia which is limited by the lateral border of the rectus sheath medially and the semilunar line of Spiegel laterally. Most SHs occur in the Spigelian belt above the arcuate line. This anatomical setting makes the access by TEP to the hernia orifice difficult for hernias located above the arcuate line, and it is even considered impossible by some authors. The aim of the study was to describe the technique of posterior rectus sheath incision (PRSI) to allow the TEP repair whatever the SH location and to evaluate long-term results of the technique.</p> Methods <p>One 10–11&#xa0;mm trocar and two 5&#xa0;mm trocars were introduced in the retrorectus space. Access to the preperitoneal space was achieved by incising the posterior rectus sheath 1&#xa0;cm medial and parallel to its lateral border. The patch was deployed with 5&#xa0;cm overlap, straddling half the retrorectus space medially and half the preperitoneal space laterally. Twenty-two cases of SHs in 21 patients were reported.</p> Results <p>There were 13 males and 8 females of mean age 61.9 years (21–88); 13 hernias were located above the arcuate line. The mean size of the hernia orifice was 2.07&#xa0;cm (1–5). Long-term evaluation was assessed in the 16 patients who had at least 12 months follow-up. After an average follow-up of 52.8 months (16–108), no recurrences were observed.</p> Conclusion <p>The PRSI technique allows the surgical treatment of SHs by TEP with good results, whatever they are located below or above the arcuate line.</p>