International guidelines for groin hernia management aim to standardize care, reduce recurrence rates, and minimize chronic pain. Developed by the HerniaSurge Group, these guidelines are endorsed by five continental hernia societies, the International Endo Hernia Society, and the European Association for Endoscopic Surgery. The guidelines are based on evidence-based medicine, with 166 key questions formulated and evaluated using Oxford, SIGN, and Grade methodologies. After five meetings, 136 statements and 88 recommendations were developed, graded as "strong" or "weak." The AGREE II instrument validated the guidelines, and three international experts reviewed them, recommending high scores. The guidelines identify risk factors for inguinal hernias, including family history, gender, age, collagen metabolism, prostatectomy, and low BMI. Perioperative risk factors for recurrence include poor surgical techniques, low surgical volumes, inexperience, and local anesthesia. Diagnosis is typically confirmed by physical examination, though ultrasound, dynamic MRI, or CT may be needed in rare cases. The EHS classification system is recommended for tailoring treatment. Symptomatic hernias should be treated surgically, while asymptomatic or minimally symptomatic male patients may be managed with watchful waiting, as their risk of emergency is low. Surgical treatment should be tailored to the surgeon's expertise, patient characteristics, and local resources. Mesh repair is recommended as the first choice, with both anterior and posterior approaches available. Laparoscopic techniques offer faster recovery, lower chronic pain risk, and cost-effectiveness, though they are not recommended for bilateral hernias. Mesh fixation is not always necessary, but recommended for large medial hernias. Antibiotic prophylaxis is not recommended for low-risk patients in open surgery or laparoscopic repair. Local anesthesia is recommended for open repair, while general anesthesia is preferred for patients over 65. Perioperative field blocks and subfascial infiltrations are recommended for open repair. Patients should resume normal activities as soon as comfortable. Women with groin hernias should undergo laparoscopic repair to reduce chronic pain risk and avoid missing femoral hernias. Pregnant women may be managed with watchful waiting, as groin swelling is often self-limited. Femoral hernias should be repaired laparoscopically if expertise is available. Complications, including chronic postoperative inguinal pain (CPIP), are discussed, with a focus on nerve recognition in open surgery and multi-disciplinary management. Recurrent hernias after anterior repair should be managed with posterior repair, and after posterior repair with anterior repair. Specialist hernia surgeons should manage failed repairs. Risk factors for incarceration/strangulation include female gender, femoral hernia, and hospitalization history. Treatment should be tailored to patient and hernia factors, local expertise, and resources. Learning curves vary, with about 100 supervised laparoscopic repairs needed to match open mesh surgery. Case load isInternational guidelines for groin hernia management aim to standardize care, reduce recurrence rates, and minimize chronic pain. Developed by the HerniaSurge Group, these guidelines are endorsed by five continental hernia societies, the International Endo Hernia Society, and the European Association for Endoscopic Surgery. The guidelines are based on evidence-based medicine, with 166 key questions formulated and evaluated using Oxford, SIGN, and Grade methodologies. After five meetings, 136 statements and 88 recommendations were developed, graded as "strong" or "weak." The AGREE II instrument validated the guidelines, and three international experts reviewed them, recommending high scores. The guidelines identify risk factors for inguinal hernias, including family history, gender, age, collagen metabolism, prostatectomy, and low BMI. Perioperative risk factors for recurrence include poor surgical techniques, low surgical volumes, inexperience, and local anesthesia. Diagnosis is typically confirmed by physical examination, though ultrasound, dynamic MRI, or CT may be needed in rare cases. The EHS classification system is recommended for tailoring treatment. Symptomatic hernias should be treated surgically, while asymptomatic or minimally symptomatic male patients may be managed with watchful waiting, as their risk of emergency is low. Surgical treatment should be tailored to the surgeon's expertise, patient characteristics, and local resources. Mesh repair is recommended as the first choice, with both anterior and posterior approaches available. Laparoscopic techniques offer faster recovery, lower chronic pain risk, and cost-effectiveness, though they are not recommended for bilateral hernias. Mesh fixation is not always necessary, but recommended for large medial hernias. Antibiotic prophylaxis is not recommended for low-risk patients in open surgery or laparoscopic repair. Local anesthesia is recommended for open repair, while general anesthesia is preferred for patients over 65. Perioperative field blocks and subfascial infiltrations are recommended for open repair. Patients should resume normal activities as soon as comfortable. Women with groin hernias should undergo laparoscopic repair to reduce chronic pain risk and avoid missing femoral hernias. Pregnant women may be managed with watchful waiting, as groin swelling is often self-limited. Femoral hernias should be repaired laparoscopically if expertise is available. Complications, including chronic postoperative inguinal pain (CPIP), are discussed, with a focus on nerve recognition in open surgery and multi-disciplinary management. Recurrent hernias after anterior repair should be managed with posterior repair, and after posterior repair with anterior repair. Specialist hernia surgeons should manage failed repairs. Risk factors for incarceration/strangulation include female gender, femoral hernia, and hospitalization history. Treatment should be tailored to patient and hernia factors, local expertise, and resources. Learning curves vary, with about 100 supervised laparoscopic repairs needed to match open mesh surgery. Case load is