Inguinal hernia repair is one of the most performed surgical procedures worldwide, and the optimal surgical technique continues to be debated. The procedure involves reinforcement of the posterior wall of the inguinal canal with a flat prosthetic mesh, avoiding tissue tension and facilitating rapid recovery. Numerous studies have demonstrated recurrence rates of less than 2% in experienced hands, contributing to its widespread adoption as the standard against which other open repairs are compared. Compared with traditional tissue repairs, the Lichtenstein technique is associated with lower recurrence rates, reduced postoperative pain related to tissue tension, and shorter operative learning curves. The Shouldice repair remains a valuable option in selected patients, particularly where mesh use is contraindicated or unavailable, but its success is highly dependent on surgical expertise. Newer mesh-based techniques have shown comparable recurrence rates; however, they have not consistently demonstrated superior outcomes over the Lichtenstein repair. Despite concerns regarding chronic postoperative groin pain and mesh-related complications, the Lichtenstein repair remains a safe, effective, and cost-efficient procedure. Current evidence supports its continued role as the gold standard open repair for inguinal hernias, while emphasizing individualized patient selection and surgeon expertise in determining the most appropriate operative approach.