Surgery of the groin hernia has become more a question of the applied tension-free, mesh technique. Whereas studies on laparascopic versus open tension-free hernia repair or open-mesh versus open-nonmesh repair have been performed sufficiently, data regarding the open tension-free plug-and-patch technique are rather poor. During the period from January 2001 to October 2003, we followed and filed 766 hernia repairs in the plug-and-patch technique of Rutkow. Follow up was during the hospital stay, 4 weeks, and minimally 12 months after operation. The main follow-up variables were complications, recurrence rate, and pain. The mean operating time was 37.8 +/- 15.85 (12-135) minutes. In 141 (19.3%) patients (n=730), the ilioinguinal nerve was resected. The 1 intraoperative complication that occurred was a severed small intestine. Length of hospital stay was 2.09 +/- 1.35 (0-17) days, work leave lasted for 15.3 +/- 12.42 (0-60) days, and return to normal daily activities was possible within 6.54 +/- 6.86 (0-35) days. Twenty-two (2.9%) patients (n=766) developed a postoperative hematoma as the most common complication, and a reoperation was required 17 (2.2%) times during the hospital stay. Early complications included hematoma (3.7%), seroma (3.5%), infection (0.2%), necrosis of 1 testicle (0.2%), persisting scrotal swelling (1.5%), persisting pain (0.9%), and hypoesthesia (2.4%). Within 4 weeks, 4 (0.9%) patients were reoperated for 1 seroma, hematoma, infection, and testicle necrosis. After 605.4 +/- 154.5 (365-1018) days, the following 19 (5.7%) patient complaints were noted: persisting pain (2.1%), hypoesthesia (1.8%), foreign-body feeling (0.6%), scrotal swelling (0.6%), and 1 (0.3%) mesh dislocation. Six (1.8%) reoperations have been performed. The overall recurrence rate was 1.8% (n=6), for primary 1.5% (n=4), and 3.3% (n=2) for recurrent hernias; 96.3% of the patients would agree to undergo the same operation a second time. Tension-free repair of the inguinal hernia by the plug-and-patch technique is a quick and secure method that simplifies hernia surgery without compromising the high-quality standards such as a low recurrence rate and low pain load of the patient. Patients had a fast recovery with a subsequent short work leave. The method is a simple, effective, and economical operation, suitable as a standard performed in local anesthesia on an out-patient basis.