Introduction: Inguinal hernia repairs are one of most commonly performed surgeries. Lichtenstein repair is popular technique and has decreased the hernia recurrence rate to less than 3%. The prosthetic mesh repair causes chronic groin pain in 15-40% of the population. Transinguinal Pre Peritoneal Repair (TIPP) by its nascent posterior approach is theoretically and practically sound alternative.It is a populartechnique in the developing countries. It can also be used in lieu of Lichtenstein repair or when laparoscopic facilities are not available or not affordable by patients. Aims and Objectives: To evaluate Transinguinalpreperitoneal mesh placement for inguinal hernia as an alternative to Lichtenstein repair. The Study compares the two procedures in terms of operative duration; Intraoperative and post-operativecomplications; postoperative pain at day 1, 7, 14, 30; chronic groin pain at 6months and reccurence within 6month. Design of the Study: A prospective randomized comparative study. Materials and Methods: A prospective randomized study was carried out in Mahatma Gandhi Medical College and Research Institute, Pondicherry, India from January 2015 to January 2016 involving 60 patients. Out of them, 30 patients each were randomly classified under two groups, who underwent Lichtenstein repair and Open Pre-peritoneal repair, and a comparative study was made between the two groups. Patients were evaluated intra-operatively and post-operatively and multiple variables assessed. Post-op pain scores were calculated using Visual Analogue Pain scores (VAS).   Mean duration of procedure, Paired t test and Independent t test were used for statistical analysis. Results: In our study of 60 patients; 50% of the patients were above 30 years , 59 (98.3%) patients are males and 42 (70%) had direct hernia. In the open pre-peritoneal group; 5 (16.7%) patients had injury to peritoneum and 2 (6.7%) patients had injury to vessels during surgery. The post-operative pain score on days 1, 7 30 and 180 (<0.0001 on day 1, 0.0001 on day 7, 0.004 on day 30 and 0.0014 on day 180) were better in patients who underwent open pre-peritoneal repair than in patients who underwent Lichtenstein repair. Conclusion: Compared to the patients who had Lichtenstein repair, Patients having Pre-peritoneal repair had no post-operative complications, returned to work earlier and enjoyed good quality of life. The study shows that TIPP repair do hold a considerable promise which needs to be investigated futher in a larger population. TIPP by its nascent posterior approach is theoretically and practically sound  alternative. 

Keywords: Inguinal Hernia; Preperitoneal Repair; Lichtenstein’s Repair; Visual Analogue Pain Scores; Blindedmanuscript.