Background Inguinal hernia repair remains one of the most common surgical procedures worldwide. While open mesh repair (Lichtenstein technique) is well established, laparoscopic approaches—Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP)—are gaining popularity for their minimally invasive advantages. This study aimed to compare postoperative outcomes, complications, and recurrence between laparoscopic and open mesh repair in adult Azerbaijani patients. Methods A prospective, randomized controlled trial was conducted at the Azerbaijan Medical University Teaching Hospital between January 2022 and December 2024. A total of 100 patients with primary unilateral inguinal hernia were randomized equally into two groups:

Laparoscopic mesh repair (TAPP or TEP)

Open mesh repair (Lichtenstein) Primary outcomes included postoperative pain (VAS 0–10), hospital stay, and return to work. Secondary outcomes were complication rates, operative time, and recurrence at 12 months. Statistical analysis employed Student’s t-test, Chi-square test, and Kaplan–Meier survival analysis, with P < 0.05 considered significant. Results Baseline demographic variables were comparable between groups. • Operative time: Laparoscopic 65.4 ± 14.2 min vs. Open 52.1 ± 11.8 min (P < 0.001) • Mean postoperative pain (VAS 24h): 3.1 ± 1.0 vs. 5.5 ± 1.2 (P < 0.001) • Hospital stays: 1.8 ± 0.7 days vs. 3.9 ± 1.2 days (P < 0.001) • Return to work: 7.2 ± 2.5 days vs. 13.6 ± 3.4 days (P < 0.001) The overall complication rate was 8% in laparoscopic vs. 22% in open repair (P = 0.041), with wound infection significantly lower in the laparoscopic group (2% vs. 10%). Recurrence at 12 months was 2% vs. 4% (P = 0.55). Recurrence-free survival: Laparoscopic 98%, Open 96% (Log-rank P = 0.47). Conclusion Laparoscopic inguinal hernia repair provides superior short-term outcomes—notably less pain, shorter hospital stays, and earlier return to work—without compromising long-term recurrence or safety. With appropriate training and institutional support, laparoscopic hernioplasty should be adopted as the preferred technique for primary and bilateral inguinal hernias in Azerbaijan and comparable healthcare systems.