Abstract Inguinal hernias are common, affecting one in four men in their lifetime. They are much less common in women with a lifetime risk of about 3%. Consequently, inguinal hernia repair is one of the commonest operations with more than 20 million operations performed annually worldwide. Africans have a much higher incidence of hernias than Caucasians and this is thought to be because of the anatomical configuration of the African pelvis. Many hernias in poorer countries are not repaired, so that presentation as an emergency and indeed mortality due to complications are much more often seen than in more affluent societies. Surgeons must be familiar with the anatomy of the groin from both the anterior and pro-peritoneal aspects. The anatomy of the inguinal region as seen from the posterior aspect has gained increasing importance, primarily because of the advent of laparoscopic repair but also because of the potential for pro-peritoneal repair using open techniques. Laparoscopic repair is recommended by the National Institute for Health and Clinical Excellence as one of the treatment options for inguinal hernia repair. Patients should be fully informed of all the risks and benefits associated with each of the three procedures offered (totally extraperitoneal, transabdominal preperitoneal or open). Recurrence rates vary widely. In large series, recurrence rates well below 1% are described. However, in real-world practice, such rates are not achieved. A more realistic figure for 10-year recurrence of a hernia repair by a general surgeon is probably 3–5%. Chronic groin pain is much commoner after inguinal hernia repair than most surgeons acknowledge, probably being evident in one-third of cases.