Controversy exists on the merits of the various approaches to inguinal repair. Evolution of the classic open repair has culminated in the Shouldice repair. Challenges from newcomers, namely, tension-free repair and laparoscopy, are being examined. These two techniques have a number of disadvantagesthe presence of foreign bodies (prostheses) and their implication in cases of infection; the cost of prosthetic material, which is no longer negligible (particularly with expanded polytetrafluoroethylene); and problems of safety in that the laparoscopic approach is no longer a dependable asset except in the hands of a highly specialized and dextrous operator. Still, complications occur with laparoscopic repair that should not be associated with a surgical procedure that is considered benign, safe and cost-effective. Surgeons must recognize the pertinent facts and decide according to their conscience which method of repair to use.