Background: Inguinal hernia repair is one of the most common surgical procedures worldwide. Despite the increasing use of laparoscopic techniques, debate continues regarding their comparative effectiveness versus open approaches. This study aimed to compare post-operative pain and recovery outcomes between laparoscopic and open inguinal hernia repair. Methods: This prospective, randomized, controlled, single-blinded trial included 180 patients with primary unilateral inguinal hernias randomized to either laparoscopic totally extraperitoneal (TEP) repair (n=90) or open Lichtenstein repair (n=90). Primary outcome was post-operative pain measured using Visual Analog Scale (VAS) at multiple time points. Secondary outcomes included analgesic requirements, hospital stay, recovery times, chronic pain incidence, complications, quality of life, and cost-effectiveness. Results: The laparoscopic group demonstrated significantly lower pain scores at all early post-operative time points (6 hours: 3.8±1.4 vs. 5.2±1.6, p<0.001; 24 hours: 2.5±1.1 vs. 3.8±1.3, p<0.001). Hospital stay was shorter in the laparoscopic group (8.7±3.5 vs. 13.9±5.2 hours, p<0.001), with earlier return to normal activities (median 5 vs. 8 days, p<0.001) and work (median 10 vs. 14 days, p<0.001). Chronic pain at 12 months was less frequent after laparoscopic repair (4.6% vs. 12.8%, p=0.049). Overall complication rates were comparable (13.3% vs. 16.7%, p=0.534). Quality of life was better in the laparoscopic group during early recovery but equalized by 6 months. From a societal perspective, laparoscopic repair was cost-effective despite higher direct costs. Conclusion: Laparoscopic inguinal hernia repair results in less post-operative pain.