Despite the fact that open inguinal hernia repair is one of the most common surgical procedures performed wordwide (with the estimation of a 20 million surgeries per year) in local (LA), regional (RA) and general (GA) anaesthesia, there is still no general agreement regarding the best anaethetic technique. Until now, several randomised trials and one meta-analysis tried to address this topic in order to define which of these three anaesthetic techniques for open inguinal hernia repair in adults is more suitable for the patient. So far, these attempts have not provided us with a clear answer. The aim of this meta-analysis is to provide the clinicians an evidence-based guidelines related to comparison of LA, RA and GA in open inguinal hernia surgery in adults based on comprehensive research of „up to date“ literature. Due to variability of anaesthetic techniques, low rate of complications as well as to small differences within the outcomes, the answer could be provided with the use of meta-analitical methods. Cochrane Library, MEDLINE, EMBASE, CINAHL, SCI-EXPANDED, SCOPUS as well as trial registries, conference proceedings and reference lists were searched irrespective of the language reported on. Twenty seven randomized controlled trials (RCTs) with a 2914 participants were included in this systematic review. LA in comparison with GA and RA has statistically significant advantages in terms of lesser complications occurence, better postoperative pain control, faster postoperative patient recovery which consequently leads to a quicker patient return to normal daily activities. The outcomes of this meta-analysis clearly demonstrate the benefits as well as drawbacks of all three types of anaesthetic techniques in open inguinal hernia repair in adults. Thus, this study contributes in a more thorough understanding each of the observed type of anaesthesia in clinical practice which significantly contributes in making the future guidelines of open inguinal hernia repair as well as in implications for further research of these issues.