Background: Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. Laparoscopic hernia repair has gained popularity due to its potential benefits, but its superiority over open repair remains controversial.

Objective: To compare the outcomes of laparoscopic versus open hernia repair in patients with primary, unilateral, reducible inguinal hernias.

Methods: This prospective, randomized single-center study included 100 patients who were randomly allocated to either laparoscopic (n=50) or open (n=50) hernia repair. Postoperative pain, analgesic requirement, hospital stay, return to normal activities, complications, and recurrence rates were assessed.

Results: Laparoscopic repair was associated with significantly lower postoperative pain scores at 24 hours (3.8 ± 1.6 vs. 5.2 ± 1.8, p<0.001), 48 hours (2.6 ± 1.4 vs. 4.1 ± 1.7, p<0.001), and 7 days (1.4 ± 1.1 vs. 2.5 ± 1.3, p<0.001). The laparoscopic group had a shorter hospital stay (1.6 ± 0.8 vs. 2.4 ± 1.1 days, p<0.001) and faster return to normal activities (10.2 ± 3.6 vs. 15.8 ± 4.2 days, p<0.001). The incidence of chronic pain was lower in the laparoscopic group at 3 months (4% vs. 16%, p=0.04) and 6 months (2% vs. 12%, p=0.05). Recurrence rates were similar between the groups at 2 years (4% vs. 6%, p=0.65).

Conclusion: Laparoscopic hernia repair is associated with reduced postoperative pain, shorter hospital stay, faster recovery, and lower rates of chronic pain compared to open repair, with similar recurrence rates at 2 years. These findings support the use of laparoscopic repair as the preferred approach for primary, unilateral, reducible inguinal hernias.