Background Incisional hernias are a frequent complication following abdominal surgeries, significantly contributing to morbidity. Surgical repair using mesh placement has become the standard of care, with ongoing debates regarding the optimal anatomical plane for mesh placement. Even though the retrorectus plane advocated by Rives and Stoppa has become the choice of plane for most surgeons, it is not without recurrence. This prospective observational study compares the outcomes of incisional hernia repair using anterectus versus retrorectus mesh placement techniques.  Patients and methods A total of 60 patients were enrolled from April 1, 2022, to April 1, 2024, at NRI Medical College & General Hospital, Vijayawada, India, divided equally into two groups. Group A included patients who underwent retrorectus hernioplasty, while Group B had anterectus hernioplasty. Parameters evaluated include epidemiological data, defect size, content, mesh size, operative time, postoperative pain, drain output, postoperative complications, hospital stay, recovery time, and recurrence rates. Results Results demonstrated a statistically significant advantage of the retrorectus approach with reduced operative time (160 ± 16 min vs. 216 ± 28 min; p < 0.0001), lower postoperative pain scores, decreased drain output, shorter hospital stays (5.6 ± 0.6 days vs. 15.7 ± 6.6 days; p < 0.0001), and fewer wound complications after a mean follow-up period of (17.4 +/- 4.7) months in group A and (18.3+/- 4.7) months in group B. Neither group had recurrences during the follow-up period. Conclusions This study concludes that retrorectus hernioplasty is superior to anterectus hernioplasty with less postoperative morbidity, shorter hospital stays, and accelerated patient recovery.