External abdominal hernia, especially inguinal hernia, is one of the most common diseases in general surgery and one of the most commonly admitted in primary care hospitals. In the opinion of many physicians, inguinal hernia repair is a simple and minor procedure that should be left to junior physicians or to junior surgeons who are eager to improve their surgical skills. As the understanding of the anatomy and etiology of this disease continues to deepen, the concept of repair has changed dramatically, and with it, the style of repair is also changing rapidly. It is no exaggeration to say that it is one of the most rapidly evolving surgical procedures in general surgery, and the most fundamental reason for this change in repair philosophy is the progressive understanding of the etiology of hernia, and the name of hernia has been changed from “hernia” to “hernia disease”. At present, hernia and abdominal wall surgery has become a veritable subspecialty in general surgery, and the Chinese Medical Association Surgery Branch has set up a special group for hernia abdominal wall surgery, which shows the importance of its academic status. Therefore, hernia is not a minor disease, and its repair surgery should not be underestimated. Throughout the evolution of hernia repair surgery, it is always associated with the level of understanding of hernia at that time, especially the evolution of inguinal hernia repair surgery. At the beginning of modern surgery, inguinal hernia was understood simply as a defect under the skin of the inguinal region that caused the herniation of intra-abdominal organs out of the abdominal wall, and the idea of repair was to close this gap and stop the herniation of intra-abdominal organs. Therefore, before Bassini Czerny established the surgical treatment of inguinal hernias: the external hernia opening is turned inward, the hernia sac is ligated, then the external ring is closed around the spermatic cord, and a hernia belt is tied to compress the external ring area postoperatively. The result of this treatment was a postoperative recurrence rate of almost 50%. Later Bassini created a unique repair, the Bassini repair, which was based on an in-depth study of the anatomy of the inguinal region and the inguinal canal in cadavers, and suggested that the cause of inguinal hernia was closely related to the abnormal structure of the inguinal canal and the presence of abdominal wall defects in this region, so the operation introduced the concept of repairing and strengthening the posterior wall of the inguinal canal, while paying attention to restoring the length and inclination of the inguinal canal. 1884 The procedure began to be formally applied in clinical practice and subsequently obtained efficacy unmatched by any other surgery at that time, with a recurrence rate of about 2.7%, much lower than the 33% reported during the same period. Therefore, it has become the classical procedure for inguinal hernia repair, which has been popular for nearly 100 years, with definite clinical results, and is still used by many surgeons. The main point of the procedure is to divide the internal oblique muscle, the transversus abdominis muscle and the transversus abdominis fascia from the superior edge of the inguinal ligament into the anterior peritoneal space, ligate the hernia sac at a high level, and suture the lower edge of the above three layers of tissue to the nodes of the inguinal ligament. Guided by this concept, there are also procedures commonly used to strengthen the posterior wall, such as Halsted and Mcvay, and those to strengthen the anterior wall, such as the Ferguson procedure. Starting in the 1970s, it has been abundantly proven that the etiology of hernias is a systemic connective tissue disease, i.e., a disease with abnormal collagen fiber metabolism. Therefore, the repair and strengthening of the transversus abdominis fascia received greater attention in inguinal hernia repair, which led to the promotion and popularity of the Shouldice repair, the key to which is the incision of the transversus abdominis fascia between the pubic tuberosity and the internal ring and the overlapping suturing of its upper and lower lobes. Thus it became a popular procedure for inguinal hernia repair in modern surgery after the 1970s. The traditional approach to hernia repair was mainly based on human anatomy, and the concept of repair was necessarily limited to intervention in the anatomical structures of the defective area and inguinal canal. The establishment of the modern concept of hernia has led to a technical revolution in inguinal hernia repair, while the development of new materials has made it possible to obtain a large amount of repair material for hernia repair, providing material support for filling the transverse abdominal fascia and the posterior wall of the inguinal canal area and filling the abdominal wall defect. The real way out of the eradication of hernia is to remove the cause of the hernia and to correct the decrease in the strength of the abdominal wall in the inguinal region. Therefore, many revolutionary leaps have been made in recent hernia repair. Since traditional repair surgery forcibly sutures different tissues together with high tension and does not heal easily, and is prone to recurrence and complications after surgery, it has become an endeavor to find new repair methods to eliminate the tension of the repaired tissue and strengthen the abdominal wall in the inguinal hernia region. Tension-free hernia repair with mesh implantation was born, and has gradually become more accepted and popular. After Acquaviva and Bourret designed the first mesh implant during World War II, polyethylene, polypropylene, polytetrafluoroethylene, and other implanted meshes were used as hernia repair materials with satisfactory results. Especially after the 1970s, patch repair has developed considerably, and Lichtenstein’s tension-free tension repair replaced Shouldice’s repair as the gold standard of inguinal repair at the end of the 20th century, whose surgical point is to cover and fix an appropriately sized repair flat sheet in the area of direct hernia and the posterior wall of the inguinal canal. The advantage is that the repair flat eliminates the need for tension sutures and reliably repairs defects and weak areas in the inguinal canal region. This concept has led to a series of other tension-free inguinal hernia repair procedures, such as the currently popular hernia ring-filling tension-free hernia repair. This method of repair has been accepted by both physicians and patients because of its precise results, ease of mastery, and small separation surface with minimal tissue damage. However, with the increase in the number of surgical cases, the number of postoperative complications has gradually increased, which has also caused widespread concern in the field. The most frequent complications include bleeding, infection, seroma, local foreign body sensation, pain, and rejection. There are even rare but serious complications such as intestinal adhesions, sterility, and intestinal fistula, which may be related to surgical malpractice, failure to master surgical principles well, foreign body reactions caused by filling materials, and the patient’s idiosyncratic constitution. This reminds us that we need to work on different aspects in order to really enhance and improve the quality of surgery, reduce complications and improve the quality of life of patients. The acceptance and promotion of the concept of tension-free hernia repair has led to the emergence of a number of other repair procedures, such as the Stopa procedure, also known as giant patch reinforced endocapsular surgery (GPRVS), in which a giant patch is placed in the anterior peritoneal space centered on the hernia sac in order to repair the abdominal wall defect. The Kugel procedure, the PHS procedure (reinforcing the pubococcygeal foramen with an “I” shaped patch repair and strengthening the hernia ring and posterior wall of the inguinal canal), etc. The methods of mesh implantation for tension-free hernia repair are numerous, but their essence is to fill the defect with a synthetic mesh or (and) to strengthen the weak abdominal wall in the area of the inguinal canal, i.e., to cover the area of the pubococcygeal foramen. All these procedures are basically performed through conventional open surgery, starting from the skin and accessing the required tissue level for surgical repair. There is no doubt that the structures and functions of the inguinal region of the patient are inevitably damaged medically while undergoing treatment, and painful incisions and infections can cause many disruptions to the patient’s life and work. With the introduction of minimally invasive concepts in hernia repair, inguinal hernia repair using laparoscopic techniques is booming, but it has not yet been introduced in primary care hospitals across the country due to technical and condition limitations. There are several types of inguinal hernia repair using laparoscopy: 1. transabdominal preperitoneal repair (TAPP) 2. Total extraperitoneal repair (TEP). 3. intracorporeal repair (IPOM). 4. others, such as simple hernia sac suturing, and various modified lumpectomy repair methods. Comparing these common laparoscopic inguinal hernia repairs, it is easy to find that TAPP, a laparoscopic approach, has outstanding advantages and disadvantages and has a lot of room for improvement, while TEP avoids the disadvantages of entering the abdomen and has low patch requirements, but the disadvantages are large separation surface, difficult operation and high technical requirements, thus requiring a laparoscopic surgeon with high technical skills to complete the operation. IPOM requires expensive IPOM requires expensive tetrafluoroethylene patches and a staple gun, so it is not routinely used except in special circumstances (e.g., urgent need to shorten operative time, reduce surgical trauma, etc.). Hernia ring suturing is not routinely used in pediatric patients or in patients with a strong posterior inguinal wall and a hernia ring less than 1.5 cm. It can be asserted that lumpectomy hernia repair will definitely be increasingly used and promoted, but it is not the ultimate method of hernia repair. Currently, there are data with 13 years of follow-up showing that the recurrence rate statistics within 5 years after inguinal hernia repair show that suture repair is significantly higher than patch repair, but after 5 years the recurrence rate of both gradually increases, i.e., it is a matter of biological recurrence. The maintenance of better results after patch repair is often within 2-4 years, which reminds us that it is not enough to focus only on anatomical recovery and mechanical strengthening of the abdominal wall when repairing inguinal hernias; the real way out of hernia repair also lies in treating the patient’s systemic connective tissue disease and correcting abnormalities in collagen fiber metabolism.