Background: Laparoscopic herniorrhaphy is controversial and deserves critical evaluation. Methods: In a randomized prospective study transabdominal preperitoneal laparoscopic herniorrhaphy (n= 24) was compared in patients to the tension-free Lichtenstein repair (n= 29) utilizing validated and reliable pain and activity assessment tools. The Sickness Impact Profile (SIP) was used to compare preoperative normal activity to postoperative activity. A Pain-O-Meter (visual analogue scale plus affective and sensory pain descriptors) assessed intensity of pain. The total pain assessment score and SIP were compared across time (postoperative day 1–42). Analgesic medication was used as a covariate. Results: The total pain score was less for laparoscopic herniorrhaphy but this did not reach statistical significance. Similarly, the SIP showed modest improvement for laparoscopic herniorrhaphy. No differences between groups were noted for morphine equivalents of administered analgesics or length of hospitalization. Conclusion: Further investigation of laparoscopic herniorrhaphy is warranted.