In the knowledge that Lichtenstein inguinal hernia repair is becoming increasingly popular we evaluated this technique in a prospective randomized study. Would the Lichtenstein repair show significant advantages in order to justify it replacing the Shouldice technique, the standard for hernia repair of the last ten years? Between January 1996 and December 1997 the study was undertaken on 385 male patients suffering from 410 primary inguinal hernias. On 164 patients the Shouldice technique (SD) was used and on 221 patients the Lichtenstein repair (LS). 50 % of the operations were performed under local anesthesia, 50 % under spinal anesthesia. The 410 operations were done by 51 different surgeons, most of them in trainee programs. The postoperative local complication rate and duration of hospitalization were similar in both groups. Significant differences were noted concerning operation-time (LS: 80 min, SD: 88 min, p < 0,005) and return to work (LS: 25 days, SD: 41 days, p < 0,00005). The tension-free repair under local anesthesia described by Lichtenstein is an easy operation, with a low complication rate and short recovery period. The Lichtenstein technique is an ideal hernia repair with low costs, high patient comfort and suitability for day-surgery.