Objective: This study aimed to compare the transthecal approach with the conservative approach for primary closure after durotomy in anterior lumbar dural tear. The study also intended to assess the efficacy of the transthecal approach to decrease postsurgical complications and costs. Materials and Methods: A total of 21 patients undergoing L2-S1 laminectomy with anterior incidental durotomy were randomly divided into a transthecal group (n=9) and a conservative group (n=12) based on the surgical dural closure technique. Postoperative pseudomeningocele, wound infection, rootlet herniation, pneumocephalus, CSF leakage, headache, meningitis, in addition to surgery duration and length of hospitalization, were examined and compared in the both groups. Results: The frequency of pseudomeningocele and CSF leakage in patients undergoing the transthecal approach was significantly lower than those undergoing the conservative approach (P=0.045 and P=0.008, respectively). Furthermore, although, the differences in the frequency of meningitis, pneumocephalus, headache, and wound infection were not statistically significant between the two groups, the effect size of the comparison was obtained 49.4, 19.8, 7.1, and 2.6, respectively. This indicated that the differences were clinically significant between the two groups. Conclusions: We found that the both approaches of dural closure, whether dural repair with the transthecal technique or the traditional conservative treatment, were safe. However, the transthecal approach was significantly more successful in managing CSF leakage as well as its complications and clinical outcomes.