Introduction: Inguinal hernia repair, a commonly performed surgical procedure, has seen a shift towards tension-free mesh repair. The Lichtenstein tension-free hernioplasty, known for its high success rate, is a leading technique in this field. This comprehensive retrospective study was conducted to thoroughly evaluate the outcomes of inguinal hernia repair using Lichtenstein's technique or free mesh tension over two years. Materials and Methods: Four hundred twenty-nine patients who underwent inguinal hernia repair with the Lichtenstein-free-tension surgery technique at the University Hospital of Trauma, Tirana, Albania, from April 2016 to March 2018, were retrospectively evaluated for demographics, recurrence, and postoperative complications. Follow-up data were obtained from hospital records, and recurrence and late complications were assessed during the telephone interview. Results: In our study, the total number of patients with inguinal hernias was 542, comprising 514 males (94.84%) and 28 females (5.16%). The mean age was 46 years (ranging from 14 to 92 years). In our study, Inguinal Hernia was recorded on the right side in 303 (55.9%) of patients, on the left side in 156 (28.7%) of patients, and 83 (15.4%) of patients had bilateral. We have recorded 429 (79.3%) patients who were treated with mesh (according to the Lichtenstein technique) and 113 (20.7%) patients who were treated without mesh (using Bassini, Shouldice, and Desarda techniques). Our study, which included 429 patients, revealed an interesting gender disparity in the occurrence of inguinal hernias. With a male-to-female ratio of 7.9:1, this difference was found to be statistically significant (P = 0.004). Conclusion: This study demonstrates that Tension-free hernia repair, introduced by Lichtenstein, remains the gold standard for open inguinal hernia repair. It is a common condition among men that increases substantially with aging. Both medial and lateral hernias have common and different etiologies. Risk factors for developing both lateral and medial hernias are older age, and it is a safe and feasible surgery method in respect to 1.8% recurrence and 16.5 % overall postoperative complication rate.