Significant innovations in surgical techniques and prosthetic materials have led to a reduction in early recurrence rates. The continued use of recurrence as the sole key performance indicator of surgical success, at the expense of ignoring patients’ outcomes, aligns poorly with evidence-based medicine in the modern age. The introduction of hernia-specific patient-reported outcome measures (PROM) and patient-reported experience measures (PREM) revealed significant post-operative chronic groin pain (POCGP) and reduction in quality of life (QoL) after seemingly‘ simple’ inguinal hernia surgeries. The perception that inguinal hernia repairs are simple, and can be offered to all without due consideration should no longer be acceptable. Inguinal hernias, as a disease entity, are complex, and a universal solution for all scenarios is likely not possible. Surgeons who manage inguinal hernias should be proficient in a variety of operative approaches (open, laparoscopy or robotic-assisted). In both open and MIS surgery must teach importance of identifying or knowing position of nerves and leaving fascial coverings around nerve to reduce risk neuralgia. The gold standard technique in inguinal hernia repair is no longer about reducing recurrence but instead a more technical focused approach in avoiding nerve injury and in ensuring appropriate mesh placement according to mesh science principles to prevent chronic inflammation around the mesh and hence pain. For a posterior approach this involves understanding the MPO its microfascial anatomy including the 5 triangles, 3 zones, 2 compartments and 9-10 rules for obtaining the critical view of the MPO.