Aim: To compare four approaches in primary repair of inguinal hernia as regards operative and postoperative outcome. 
Methods: One hundred consecutive patients with primary inguinal hernia Nyhus I-III were randomized into four groups. 
Group I had Open pro-peritoneal repair, group II had Lichtenstein tension-free mesh repair, group III had 
Transabdominal pro-peritoneal repair (TAPP) while group IV had laparoscopic totally extraperitoneal hernia (TEP) 
repair. 
Results: Operative time ranged from 10.71 to 120.61 minutes. Laparoscopic operations were significantly longer than 
open operations (54.5+13.2, 34.21+23.5 versus 96.12+22.5, 77.4+43.21; t = 3.891, p <0.001). Open pro-peritoneal approach 
had significantly longer operative time compared to Lichtenstein approach (54.5+13.2 versus 34.21+23.5). Postoperative 
pain was significantly higher in patients who had open repairs (7.067+1.831, 6.5+3.5 versus 5.8 +1.568, 4.8+2.33; t = 3.424, 
p = 0.002). There was one case of conversion in each of the two laparoscopic groups. Laparoscopic operations were 
associated with significantly faster return to normal domestic activities and to work. 
Conclusion: Laparoscopic hernia repair offers less postoperative pain and rapid recovery on the expense of longer 
operative time. TEP and TAPP laparoscopic techniques gave similar results.