Purpose: Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair (IHR) is a widely adopted surgical technique offering improved postoperative outcomes compared to open repair. While cyanoacrylate glue and absorbable tacks are both commonly used for mesh fixation, there are limited long-term data, particularly within the Australian context, that exist comparing their outcomes. Methodology: We conducted a long-term (> 5 years) follow-up for 58 patients with 84 hernias from our previous randomised controlled trial published in 2017, to compare post-operative outcomes of cyanoacrylate glue and absorbable tack fixation. Primary outcomes included chronic postoperative inguinal pain (CPIP), Carolinas Comfort Scale (CCS) scores, and recurrence. For secondary outcomes, we illustrated a heatmap of mesh fixation points onto the abdominal wall in order to correlate fixation location with post-operative outcomes. Results: CPIP prevalence was insignificantly higher in the glue group (15.60%) than the tack group (5.13%) (p = 0.198). Recurrence was rare with only 3 total cases. Incidentally, 14 participants reported extended avoidance of heavy lifting due to fear of recurrence 7 years post-operatively that may modify the results. A positive correlation was found between long-term pain and both pain at day 90 (r=0.237, p=0.033) and day 180 (r=0.259, p=0.021) while preoperative pain was not predictive of postoperative outcomes. Fixation inferolateral to the iliopubic tract was associated with more CPIP (p = 0.042). Conclusions: Either cyanoacrylate glue or tacks are viable alternatives in mesh fixation during laparoscopic TEP hernia repair and show comparable long-term outcomes. Chronic pain, when present at 3 or 6 months postoperatively, is likely to persist and warrants early intervention.