PURPOSE: This study aims to compare the outcomes of laparoscopic versus open repair techniques in patients undergoing emergency surgery for incarcerated incisional hernia in a tertiary care setting. METHODS: A prospective evaluation was conducted on 45 patients who underwent emergency laparoscopic and open repair for incarcerated incisional hernia between 2018 and August 2021. Patients were divided into two groups based on the surgical technique used: laparoscopic (n = 15) and open repair (n = 30). Key variables analysed included demographic data, body mass index, American Society of Anesthesiologists scores, operative time, perioperative bleeding, length of hospital stay, postoperative complications, European Hernia Society Quality of Life pain score, and recurrence rates during follow-up. RESULTS: Significant differences were found between the laparoscopic and open repair groups regarding pain scores, length of hospital stay, and amount of perioperative bleeding. The laparoscopic repair group demonstrated reduced pain, shorter hospital stays, and less perioperative bleeding compared to the open repair group. CONCLUSION: This study shows that laparoscopic repair for incarcerated incisional hernia offers significant advantages over open repair. These findings support the preference for laparoscopic repair in the emergency surgical management of incarcerated incisional hernia in appropriate patients.