Abstract: Objective：To evaluate and compare the efficacy of laparoscopic and open tension-free surgery for adult unilateral primary inguinal hernia. Methods：Randomized controlled trial (RCT) reports published from 2006 to 2016 were searched in the PubMed, EMBASE, Web of Science, CBM and VIP databases. Data related to the clinical outcome, which compared the efficacy of laparoscopic and open surgery for adult unilateral primary inguinal hernia, were independently extracted and analyzed by two reviewers according to Cochrane Handbook for Systematic Reviews of Interventions 5.0.1. Statistical analysis was performed using RevMan 5.3 software. Results：A total of 3 200 adult patients with unilateral primary inguinal hernia from 12 RCTs in 13 papers were enrolled in this Meta-analysis. Compared with open surgery, the cost of hospitalization in laparoscopic repair group increased (SMD=4.99，95%CI 3.13-6.85, P<0.001), and the rates of complication occurrence (RR=0.82，95%CI 0.68-0.98, P=0.03), NRS (MD=-1.67, 95%CI -2.29- -1.05, P<0.001) and persistent pain recurrence (RR=0.40, 95%CI 0.23-0.69, P=0.001) reduced. However, there was no significant difference in the operation time (MD=0.14, 95%CI 2.69-2.97, P=0.92) and the recurrence rate (RR=0.96, 95%CI 0.32-2.88, P=0.06). Conclusions：Compared with open surgery, laparoscopic surgery is superior for adult primary unilateral inguinal hernia, but with higher cost. Accordingly, the appropriate surgical operation should be selected.