Mesh fixation in laparoscopic ventral hernia repair requires the use of tacks and/or permanent transabdominal sutures. Sutures pass through all fascial and muscle layers of the anterior abdominal wall, whereas tacks secure the mesh simply to peritoneum. Controversy exists regarding the optimal fixation method. In this pilot study, we compared recurrence rates between these two techniques. Patients undergoing laparoscopic ventral hernia repair at the Mount Sinai Medical Center were prospectively and nonrandomly enrolled in the study and underwent either suture-fixation or tack-fixation. Office charts, computed tomography, and telephone interviews were used to determine recurrence events. chi2 and Student's t tests were performed to compare group characteristics and multivariate Cox regression analysis was used to assess for recurrence predictors after adjusting for potential confounders. From 2004 to 2005, 27 patients had suture repairs and 21 had tack repairs. The two groups had similar demographic, history, and operative variables. At a mean follow-up of 18 months, the recurrence rate was 14 per cent. In multivariate analyses, fixation method did not significantly affect recurrence. In this pilot study, patients undergoing laparoscopic ventral hernia repair with primarily transabdominal sutures or tacks experienced similar recurrence rates. Future studies will be needed to validate these findings.