Background and Aim: Ventral abdominal wall hernias are a common surgical condition that significantly impacts patient morbidity and healthcare resources. The management of these hernias often involves mesh repair techniques, with onlay and sublay approaches being widely used. This study aimed to compare the outcomes of these two techniques in terms of postoperative recovery, complication rates, and recurrence. Material and methods: A prospective observational study was conducted at the National Institute of Medical Sciences & Research Hospital, Jaipur. A total of 140 patients were randomized into two groups: onlay (n=70) and sublay (n=70) mesh repair. Data were collected on operative time, postoperative complications (pain, wound infections, seroma, hematoma), length of hospital stay, and recurrence. Result: The sublay repair technique demonstrated several advantages over the onlay approach. Seroma formation was significantly lower in the sublay group (10.8%) compared to the onlay group (29.3%). ASEPSIS scores showed satisfactory wound healing in 90.0% of sublay patients versus 70.0% of onlay patients. Hospital stay was shorter in the sublay group (3.60 ± 1.63 days vs. 4.16 ± 1.72 days; p = 0.047), and recurrence rates were also lower (2.7% vs. 7.3%). While sublay repair required longer operative times, it resulted in better pain management, with fewer patients reporting severe pain (p = 0.001). Conclusion: Sublay mesh repair offers significant advantages in reducing postoperative complications, enhancing wound healing, and lowering recurrence rates compared to the onlay technique. Despite its longer operative time, sublay repair emerges as a preferred approach for ventral hernia management, emphasizing the importance of personalized surgical planning.