Back to basics: why open groin hernia repair still deserves center stage?

In an age of surgical innovation, the shift toward minimally invasive inguinal hernia repair demands critical reappraisal. Large-scale data and registry analyses reveal no consistent superiority of laparoscopic or robotic techniques over the traditional open repair, particularly regarding recurrence, complications, chronic pain, or patient satisfaction. The open Lichtenstein approach, often undervalued, remains a pragmatic, cost-effective, and evidence-based option, especially in high-risk or resource-limited settings. The enduring appeal of minimally invasive techniques appears increasingly driven by industry, training hierarchies, perceived prestige, and surgical showmanship rather than clear patient benefit.