Background The goal of the present research was to study patients who underwent laparoscopic total extraperitoneal repair using slit and non-slit mesh placement. Methods Patients who underwent laparoscopic inguinal hernia repair in our hospital between 2005 and 2009 were interviewed and examined. Surgery outcome, hernia recurrence, postoperative pain and time to return to normal physical activities, and surgery satisfaction were compared. Results During the study period 389 consecutive patients underwent laparoscopic groin hernia repair: 387 by the total extraperitoneal (TEP) approach and 2 by the TAPP approach. Six of the TEP patients were converted to TAPP. Eighty-seven patients in the TEP group had slit mesh placement and 300 had non-slit mesh placement. Mean follow-up was 36 months (range: 6-66 months). At followup, 387 patients responded to a request for interview and 277 were examined. The overall recurrence rate was 4.7%, the incidence of constant postoperative pain was 1.3%, the presence of permanent testicular pain was 2.8%, and patient satisfaction with the surgery was 94.5%. A significantly lower recurrence rate was found in the slit mesh group than in the non-slit group (0.6% versus 5.9%; p<0.003). There was no difference in the length of time until return to normal activities, patient satisfaction, and postoperative pain between the groups. Surgery time and the occurrence of testicular pain were significantly greater in the anatomic group. Conclusions Total extraperitoneal inguinal hernia repair with slit mesh placement is a safe technique with a very low recurrence rate and is superior to non-slit mesh positioning.