Background Up till now, there is a great concern about the optimal technique for repair of AQ4 recurrent inguinal hernia. The aim of this study was to evaluate the outcome of transabdominal preperitoneal (TAPP) repair versus open preperitoneal approach for treatment of recurrent inguinal hernia. Patients and methods The present study included 72 male patients with recurrent inguinal hernia who were randomly allocated into two groups: group A (n=36) underwent TAPP, whereas group B (n=36) underwent open preperitoneal repair. For both groups, the operative time, intraoperative complications, postoperative complications, hospital stay, and return to normal activities were recorded. Follow-up was designed for 1 month for early postoperative complications and up to 2 years for recurrence. Results The mean age of the included patients was 42±15.2 and 44±11.9 years in groups A and B, respectively. There was no statistically significant difference between the mean operative time between both groups (P=0.064) and the mean hospital stay (0.34). The reported intraoperative complications showed no statistically difference between both groups. Seroma was reported in four (11.1%) cases in group B, and this was significantly higher than that reported in group A, where only one (2.8%) case was reported of postoperative seroma. There was no statistically significant difference in the 2-year follow-up recurrence in the two groups (P=0.092). Conclusion Both TAPP and open preperitoneal are reliable and applicable procedures for treatment of recurrent inguinal hernia with a low recurrence rate and minimal postoperative complications.