Purpose Studies comparing laparoscopic (LIHR) vs. open inguinal hernia repair (OIHR) have shown similar recurrence rates but have disagreed on perioperative outcomes and costs. The aim of this study is to compare laparoscopic vs. open outcomes and costs. Methods The National Surgical Quality Improvement Program (NSQIP) was used to compare durations of surgery, anesthesia time, and length of stay (LOS). The University HealthSystem Consortium (UHC) was used to review the cost and complications between approaches. Patients were matched on demographics, year of procedure and surgical approach between datasets for statistical analysis. Results A sample of 5468 patients undergoing OIHR (N= 4,693) or LIHR (N= 775) was selected from UHC from 2008–2011. An identical number of patients from NSQIP were matched to those from UHC resulting in a total of 10,936 records. LIHR patients had shorter duration of wait from admission to operation (p< 0.05). Conversely, LIHR patients had longer operating time (p< 0.05), duration of anesthesia (p< 0.05), and time in the operating room (p< 0.05). Overall complication rate was higher in open (3.1 vs. 1.8%, p< 0.05). Cost favored open over LIHR (4360vs 5105). The cost discrepancy mainly stemmed from LIHR supplies (1448vs. 340; p< 0.05) and OR services (1380vs. 1080; p< 0.05). Conclusion This study demonstrates the LOS and perioperative outcomes were superior in the LIHR group; however, the overall cost was higher due to the supplies. Advancement in technology, surgeons’ skill level and preference of supplies are all factors in decreasing the overall cost of LIHR.