Abstract Objective The objective of this meta-analysis is to compare the outcomes of prophylactic ilioinguinal neurectomy versus ilioinguinal nerve preservation for open inguinal hernia repair. Methods Studies reporting the patient outcomes were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Seven studies on 1,333 patients reporting post-operative outcomes were included. In the random effect model analysis, the severe pain at the end of the follow-up period [odds ratio (OR) 0.45, 95%, CI (0.10, 2.08), Z = 1.03, p = 0.30] was similar in both the groups with high heterogeneity (Tau2 = 0.97; Chi2 = 4.45, df = 1 (P = 0.03; I2 = 78 %) among included studies. Hypoesthesia at 6-month follow-up period [odds ratio 1.00, 95%, CI (0.47, 2.15), Z = 0.00, p = 1.00] suggests comparable outcomes in both groups with no heterogeneity among the included studies. The absence of pain reported by patients at the 6-month follow-up period [odds ratio 0.96, 95%, CI (0.72, 1.27), Z = 0.28, P = 0.78] suggests comparable outcomes in both groups with no heterogeneity among the included studies. Conclusion Post-operative outcomes like chronic groin pain, hypoesthesia or no pain reported by patients were similar in both groups. There was a paucity of data, therefore a major multicentre randomised control trial is recommended to strengthen the findings of this meta-analysis.