Introduction: Hernia surgery remains a common procedure with evolving techniques, presenting challenges such as chronic groin pain. Ilioinguinal nerve division and preservation during hernia repair influence pain and hypoesthesia outcomes, sparking interest in optimizing patient outcomes. Methods: This prospective observational study included 80 cases conducted in a tertiary care teaching hospital in South India. Patients aged 18 and above with direct or indirect inguinal hernias were assigned to two groups: ilioinguinal nerve preservation (Group A) and division (Group B). Pain and hypoesthesia were assessed at one, three, and six months post-surgery using validated questionnaires and sensory testing. Results: Both groups (A and B) had comparable age and gender distributions. Pain at rest was significantly higher in the preserved group (Group A) compared to the divided group (Group B) at all time intervals. Pain during regular activities showed no significant difference at one month, but the preserved group (Group A) reported higher pain at the third and sixth months. Hypoesthesia was consistently higher in the divided group (Group B) compared to the preserved group (Group A) across all time points. Pain reduction was significant over time in the divided group (Group B), particularly among complete hernia patients. Diabetes mellitus did not significantly influence pain or hypoesthesia. Conclusion: This study demonstrates substantial differences in pain and hypoesthesia outcomes based on ilioinguinal nerve division or preservation during hernia repair. While preserved group experienced greater pain at rest and during regular activities at later time points, the divided group consistently exhibited increased hypoesthesia. These findings underline the complexity of balancing pain reduction and sensory outcomes in hernia surgery