The repair of a simple inguinal hernia or a complicated incisional hernia no longer involves just the sewing together of a defect in the musculature. Present-day hernia operations require that the surgeon more fully understand the functional anatomy and pathophysiology of the abdominal wall and groin. Hernia surgeons must be familiar with a myriad of surgical techniques, ranging from the traditional tissue repairs with suture to the mesh-based "tension-free" open and laparoscopic techniques. Furthermore, the surgeon must comprehend outcome analysis in evaluating differing therapies. Several approaches have been used for repair of groin hernias and have included tissue repairs (later termed "tension" repairs), as well as mesh or tension-free repairs and laparoscopy. Although each of these repairs boasts its successes, there are advantages and disadvantages to each approach. This article highlights each of these repairs through review of the literature.