ObjectiveTo systematically review the effectiveness and safety of the open preperitoneal approaches and the Lichtenstein technique in the repair of inguinal hernias. MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library (Issue 10, 2013), CBM, CNKI, WanFang Data and VIP were electronically searched for relevant studies from their inception to October 2013. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.2.5 software. ResultsA total of 9 RCT involving 1 246 patients were included. The results of meta-analysis showed that:compared with Lichtenstein repair, the preperitoneal technique was associated with a lower incidence of chronic pain (RR=0.39, 95%CI 0.26 to 0.58, P < 0.000 01), sensation of a foreign body (RR=0.49, 95%CI 0.31 to 0.79, P=0.003), recurrence (RR=0.37, 95%CI 0.15 to 0.89, P=0.03), and hematoma (RR=0.41, 95%CI 0.26 to 0.67, P=0.000 3). However, there was no significant difference in the incidence of wound infection (RR=0.89, 95%CI 0.29 to 2.76, P=0.85) and urine retention (RR=0.75, 95%CI 0.35 to 1.61, P=0.46). ConclusionThe open preperitoneal approach is a feasible alternative for inguinal hernia repair with less postoperative complication compared with Lichtenstein procedure. Due to the limited quantity and quality of the included studies, the aforementioned conclusion still needs to be verified by conducting more high quality studies.