Background: Paraumbilical hernias are a common surgical problem constituting about 33% of all anterior abdominal wall hernias. Since Mayo popularized the simple suture repair, there has been a continuous evolution of different techniques for the repair of paraumbilical hernias owing to the high recurrence rate attendant to the simple suture repair. With the advent of mesh came significant wound complications that led surgeons to introduce the laparoscopic technique. However, there is as yet no consensus on the optimal repair technique for paraumbilical hernias. Aim: comparison between herniorrhaphy alone versus hernioplasty in small-sized paraumbilical hernia. Material and methods: A Prospective study was conducted in the Department of General Surgery, Patna Medical College and Hospital,Patna, Bihar, India for 18 months. The study included 120 patients divided into two groups .Group 1 was included 60 patients randomized to paraumbilical hernioplasty with mesh insertion. Group 2 was included 60 patients randomized to paraumbilical herniorrhaphy. Paraumbilical hernia patients aging 20-60 years old with small defect size (less than 3 cm) by preoperative ultrasound. A transverse incision was made, and the sac was dissected all around. Opening of the sac at the neck and exposure of the contents was done then excision of the sac. Suture (anatomical) repair of the defect was done using polyprolene sutures. In group (1), mesh was then inserted and fixed with interrupted polyprolene sutures, while in group (2) and only anatomical suture repair was done without mesh use. Results: Gender of patients in both groups: In group (1): 25 males (41.67% of group) and 35 females (58.33% of group), while in group (2): 28 males and 32 females with p=0.45. Comparison of age of patients in both groups, it was found that: In both groups the range of age was 24-57 years old with p=0.632. There were significant differences between both groups as regarding operative details.Drain was inserted in only 40 patients of group (2) while all patients of group (1) had drains inserted p≤0.001. Incision size mean in group (1) was about 11.07±1.26 cm. while in group (2) it was only 8.87±0.82 cm with p≤0.001. Also, operation time was reduced in herniorrhaphy group with a mean 31.15±3.11 minutes while in hernioplasty group was 41.23±3.17 minutes with p≤0.001. In comparison between both groups in wound complications, it was found that seroma occurred in 4 patients of group (1) and 2 patient in group (2) p=0.298. Infection occurred in 6 patients in group (1) while only 2 patient in group (2) had wound infection p=0.177. Dehiscence occurred in only 2 patient in group (1) with p=0.336. As regarding recurrence rates, both groups had no statistically significant differences during the 6-month follow-up period; only 2 case had herniarecurrence, which was identified clinically and by ultrasonography after 5 months of operation in group (2) while no cases in group (1) had hernia recurrence during the period of follow-up with p=0.336. Conclusion: We concluded that the anatomical non-mesh repair of small-sized paraumbilical hernia had significant correlation with shorter duration of operation, smaller incision size and lowered overall costs than mesh repairs.