Inguinal hernia repair is among the most performed operations worldwide, and mesh-based tension-free techniques have become the standard of care because of their low recurrence rates and favorable postoperative outcomes. The Prolene Hernia System (PHS), introduced by Gilbert, consists of a bilayer polypropylene mesh designed to reinforce both the posterior preperitoneal space and the anterior inguinal floor through a single anterior approach. The theoretical advantages of the PHS include comprehensive coverage of the myopectineal orifice, reduced recurrence risk, minimal tissue tension, and improved biomechanical support. Several randomized controlled trials and observational studies have compared PHS with Lichtenstein repair and other mesh-based techniques. Current evidence demonstrates comparable recurrence rates, chronic pain outcomes, and complication profiles, while some studies suggest shorter operative times and faster convalescence with PHS. Although laparoscopic and robotic approaches have gained popularity, PHS remains a valuable open repair option, particularly in selected patients undergoing primary unilateral inguinal hernia repair. This review examines the Prolene hernia system and compares it with the Lichtenstein and plug mesh repair.