The principle of inguinal hernia treatment in adults is surgical, and the current surgical option is a tension-free repair procedure using patch material. Surgery is subdivided into two routes, which used to be routinely achieved by open surgery, that is, by making a cut in the inguinal area where the hernia protrudes. In the last decade, with the increasing use of laparoscopic surgery, laparoscopic tension-free hernia repair has been performed in some tertiary care hospitals. Laparoscopy is usually considered to be minimally invasive and therefore has gained some patients’ favor, but there are also concerns about the high recurrence rate of laparoscopic surgery and also about the high impact of general anesthesia on the body. But is it better to have open surgery or laparoscopic surgery? Even in many doctors’ mouths, the views are not consistent, so many patients with some medical knowledge are torn and do not know how to make the right choice. So let’s discuss it today. First of all, essentially both are the same, both use patches to achieve a tension-free repair, i.e. both place the patch in the area where the inguinal hernia occurs. As long as the surgery is done properly and the patch is well placed, the repair results of both are exactly the same and the recurrence rate is very low, not higher than 1%. The difference between the two is the route of operation: open surgery is done through a 4-6 cm incision in the inguinal region, while laparoscopic surgery is done through three small 0.5-1 cm holes in the lower abdominal wall above the inguinal region to place lenses and instruments to complete the operation. The former requires incision of the abdominal wall in the inguinal region, which is more traumatic to the abdominal wall and spermatic cord and has a greater potential for local nerve injury, while the latter is less traumatic to the abdominal wall and spermatic cord, so the patient’s postoperative recovery is usually faster and there is less potential for nerve injury. Laparoscopic surgery is done completely under direct vision for anatomical separation and patch placement, which is more precise than some open surgeries with preperitoneal patch placement, and this is an important reason why laparoscopic surgery is not inferior to open surgery. Also, laparoscopy is very suitable for bilateral hernias and recurrent hernias, why is that? The three small holes made by laparoscopy are able to complete the surgery on both sides at the same time, while open surgery is usually limited to one incision on the left side and one on the right side, which is obviously more traumatic; patients with recurrent hernia have already had a history of surgery and the anatomy of the abdominal wall will be changed to a certain extent, so it is indeed more direct and convenient to see and operate from the inside through the laparoscope than through open surgery from the outside. Laparoscopy also allows for the exploration of the contralateral side and the timely detection of a contralateral occult hernia without clinical manifestations, which cannot be done by unilateral open surgery. Given all the benefits of laparoscopy, are all patients suitable for laparoscopic hernia repair surgery? The answer is certainly not. Because laparoscopic surgery requires gas injection to create space, general anesthesia is necessary to safely complete the procedure, and the effects of general anesthesia on older patients who already have more severe cardiopulmonary disease are greater than the effects of semi-body or local anesthesia during open surgery, making these patients unsuitable for laparoscopic surgery. Secondly, those patients with a long history of a large hernia that has entered the scrotum and become a difficult hernia are also less suitable for laparoscopic surgery because of the need to separate the intestinal canal adhering to the hernia sac. In addition, those with a history of major surgery in the lower abdomen, especially those who have had prostate and bladder surgery, are mostly also not suitable for laparoscopic surgery due to the presence of adhesions in the abdominal cavity and the repaired gap. However, in general, more than 90% of patients are still able to undergo laparoscopic surgery. Another disadvantage of laparoscopy is that the cost is higher than that of open surgery, due to the increased cost of general anesthesia and instruments; in addition, it requires a higher level of operation from the surgeon. The recurrence rate reported in the early days after laparoscopic surgery was actually higher than that of open surgery because the operation was not mature enough; now that laparoscopic technology is mature, the recurrence rate is comparable to or even lower than that of open surgery. Finally, let’s summarize how to choose laparoscopic and open surgery. In patients with bilateral hernias and recurrent hernias or unilateral hernias where the contralateral hernia cannot be ruled out clinically, laparoscopy is preferred; 2. Elderly patients who are not too old or do not have serious cardiopulmonary disease and wish to resume normal work and life as soon as possible after surgery, laparoscopy is preferred; 3. Elderly patients who already have more serious cardiopulmonary disease, open surgery under local anesthesia or hemianesthesia is preferred; 4. Patients with a long history of huge hernias into the scrotum Open surgery is preferred for patients with a long history of hernia into the scrotum and difficult-to-recover hernia; 5. Open surgery is preferred for patients with a history of major surgery in the lower abdomen, especially those who have had prostate and bladder surgery; 6. In fact, most patients with inguinal hernia can choose both methods clinically, and in general inguinal hernia surgery, whether open or laparoscopic, is a very safe routine surgery in the surgical clinic, so patients do not need to worry too much about the choice of surgery. It is recommended to consult with a hernia specialist who performs both open and laparoscopic surgery. We will follow the principle of individualized treatment and make a final decision on your surgical approach according to your specific situation, which will definitely help you solve this troublesome little disease of inguinal hernia.