Objective To compare outcomes of open and laparoscopic repair for recurrent inguinal hernia and identify risk factors of postoperative complications. Methods A retrospective analysis was conducted on the clinical data of 94 patients with recurrent inguinal hernia who underwent tension-free repair at The First Affiliated Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou Central Hospital, Xuchang Central Hospital and Luoyang Central Hospital between January and December 2023. Hernia defect diameter, hernia position, hernia type, repair method, operation time, urinary retention, wound infection, hematoma, seroma and hospital stay were recorded. Follow-up included hernia recurrence, chronic pain, foreign body sensation and quality of life. Results Twenty-one patients underwent open repair, and 73 patients underwent laparoscopic surgery. Postoperatively, urinary retention occurred in 10 patients, surgical site infection occurred in 4, hematoma occurred in 5, and seroma occurred in 6. Follow-up was completed on 89 patients, among whom 4 experienced recurrence, 8 had chronic pain, and 14 reported foreign body sensation. The 36-item short-form general survey questionnaire (SF-36) score was 24 (21, 26). Sixty-five patients had undergone open surgery previously, of whom 59 received laparoscopic repair in the current operation. Twenty-four patients had undergone laparoscopic surgery previously, of whom 14 underwent open surgery in the current operation. Six patients underwent open surgery twice, and 10 patients underwent laparoscopic surgery twice. The SF-36 score was significantly higher in patients who underwent laparoscopic surgery twice than in those who underwent open surgery twice (P=0.042). There were statistically significant differences between the laparoscopic and open surgery groups in the proportion of American Society of Anesthesiologists (ASA) physical status classification, hernia ring diameter and length of hospital stay（P<0.001、<0.001、=0.002）. Univariate analysis revealed that for patients with recurrent inguinal hernia, the presence of coronary heart disease, BPH and advanced age were risk factors for postoperative recurrence (P=0.012, 0.021, 0.043). Bilateral hernia was a risk factor for chronic postoperative pain (P=0.021), while lower ASA classification and the occurrence of seroma during the perioperative period were risk factors for postoperative foreign body sensation (P=0.021, <0.001). Multivariate analysis showed that seroma was an independent risk factor for postoperative foreign body sensation (OR=35.482, 95%CI 3.491-360.585, P=0.003). Conclusion The efficacy of laparoscopic surgery and open surgery in treating recurrent inguinal hernia is comparable. For elderly patients with comorbid coronary heart disease and BPH, thorough evaluation and management are required to reduce recurrence risk; bilateral hernia patients may benefit from multimodal analgesia postoperatively; measures should be taken to prevent seroma formation and minimize foreign body sensation.