The underlying cause of all types of inguinal hernias is a deep weakness in the inguinal region, which was described by Dr. Fruchard in France as the “pubic foramen”. The entire pubic foramen has only one layer, the transversus abdominis fascia, to withstand the pressure in the abdominal cavity. The transversus abdominis fascia plays a key role, and when it becomes fissured, weakened, or deficient, an inguinal hernia, a straight hernia, or a femoral hernia can occur. All types of inguinal hernias originate from the pubic ramus, and repair of the pubic ramus (transversus abdominis fascia) is the real meaning of inguinal hernia repair. The transversus abdominis fascia is divided into two layers, the anterior and posterior, the anterior layer is attached to the transversus abdominis muscle and the back of the tendon membrane, the posterior layer consists of irregular thickening of the fibrous bundles of tissue and adipose tissue, and easy to separate from the peritoneal layer, there are the abdominal wall under the arteries and veins and the genitofemoral nerve of the genitofemoral branch passes through between two layers. The anterior peritoneal space is the space between the peritoneum and the transversal abdominal fascia, also understood as the Bogros space. Currently, representative preperitoneal repair procedures include Kugel tension-free hernia repair, PHS tension-free hernia repair, D10 tension-free hernia repair and laparoscopic hernia repair (TAPP, TEP), which are reported in the literature to be more in line with the local anatomy and physiology of the body, with less postoperative foreign body sensation and pain, and have received more and more attention abroad, and have been gradually carried out in China. The common features of these surgical methods of placing the repair material in the anterior peritoneal space are minimally invasive, small incision, short operation time, fewer sutures, less pain, less postoperative foreign body sensation, beneficial to those with potential fertility requirements, fewer complications, very little chronic pain; fast recovery and low recurrence rate. Local anesthesia, can be completed on an outpatient basis, low requirements for the patient’s own underlying disease, can be completed and safe for those who could not be performed in the past due to underlying disease. We practice surgery, incision length of about 3 ~ 4cm, the average operating time of less than half an hour, the incidence of postoperative complications close to 0, short hospitalization, less money, low cost, fast recovery, the average follow-up of 9 months, the recurrence rate of 0.024%, the foreign body sensation is not obvious. Indications for preperitoneal inguinal tension-free hernia repair surgery: (1) primary inguinal hernia; (2) primary inguinal hernia; (3) recurrent inguinal hernia; (4) saddle hernia. Intraoperative experience and precautions in preperitoneal inguinal tension-free hernia repair surgery: (1) Incision of the transversal abdominal fascia is particularly important, the level should be correct, the “neck and shoulder technique”, “spermatic cord abdominal wall” should be understood thoroughly, and the operation should be accurate; (2) Under direct vision, the preperitoneal interval should be separated by hand or wet gauze, and the preperitoneal interval should be separated by hand or wet gauze. (2) Separation of the preperitoneal space by hand or wet gauze under direct vision should be easy. If it is difficult or there is resistance, it must not be in the preperitoneal space, and the preperitoneal space should be found again, and then separated; (3) The subperitoneal arteries and veins should be seen and separated underneath them, and the patch should be spread underneath them; (4) The patch should always be spread, and the lower edge should be placed underneath the pubic bone. In this case, a case of recurrence, re-operation confirmed that the patch is not sufficiently flattened, the lower edge of the curled caused. (5) straight hernia may not free the spermatic cord, but do not injure the blood vessels, nerves and vas deferens on the spermatic cord when suturing the transversus abdominis fascia; (6) when the transversus abdominis fascia is weak or the defect is large, the transversus abdominis fascia should be repaired or folded and sutured to prevent the patch from protruding out. Open preperitoneal inguinal hernia repair under local anesthesia will have shorter operation time, lower operation cost, more in line with the local anatomy and physiology, no postoperative foreign body sensation and discomfort, faster recovery and lower recurrence rate. Therefore, open preperitoneal inguinal hernia repair under local anesthesia provides cost-effective, minimally invasive, safe and reliable hernia repair.