Objective <p>This study aimed to compare the intraoperative and postoperative outcomes of laparoscopic intraperitoneal onlay mesh repair (IPOM) and transabdominal preperitoneal repair (TAPP) for adult umbilical hernia and to provide clinical evidence for procedure selection.</p> Methods <p>We retrospectively reviewed adult patients with umbilical hernia who underwent laparoscopic IPOM or TAPP at a single tertiary referral center between July 2021 and July 2024. Baseline characteristics, operative variables, postoperative pain scores, and postoperative complications were compared between the two groups.</p> Results <p>A total of 69 patients were included, including 39 in the IPOM group and 30 in the TAPP group. Baseline characteristics were comparable between groups. The mean operative time was significantly longer in the TAPP group than in the IPOM group. However, postoperative VAS pain scores on the day of surgery and on postoperative days 1 and 7 were significantly lower in the TAPP group. No significant between-group differences were observed in intraoperative blood loss, length of hospital stay, postoperative complications, or recurrence during follow-up.</p> Conclusion <p>Both laparoscopic IPOM and TAPP were safe and feasible for the treatment of adult umbilical hernia in this cohort. Although TAPP required a longer operative time, it was associated with lower short-term postoperative pain. No significant differences were observed in recurrence or complication rates. Larger prospective studies are needed to further clarify the comparative effectiveness of these two techniques.</p>