Objective The aim of this study is to explore the clinical effects between totally extraperitoneal laparoscopic herniorrhaphy(TEP) and open tension-free hernia repairs in adults. Methods The electronic databases PubMed、EMbase、CBM、CNKI and Wanfang were used to search for articles from January 1990 to December 2013 in any language. We collected published randomized controlled trials about TEP versus open tension-free hernia repairs in adults. The evaluation criteria included postoperative complications, chronic pain, recurrence rate, operation time , cost and time to return to normal work. The data was analyzed using the statistic software Review Manager 5.2. Results Total 30 trials involving 6994 participants were included in this meta-analysis. A significant longer operation time［SMD=0.52,95%CI(0.14,0.90),P=0.007］was observed in TEP group compared with open repair group; The cost［SMD=4.19,95%CI(3.34,5.04), P<0.00001］was much higher in TEP group; Compared with open repair method, time to return to normal work［SMD=-1.44,95%CI(-1.96,-0.92), P<0.00001］was shortened in TEP method; There is no significant difference in recurrence rate［OR=0.92,95%CI(0.61,1.39),P=0.71］and postoperative complications［OR=1.14,95%CI(0.88,1.48),P=0.32］between the two groups , while TEP has obvious advantages in less wound infection［OR=0.34,95%CI(0.18,0.64),P=0.0008］and chronic pain［OR=0.47,95%CI(0.25,0.88),P=0.02］.. Conclusions Current evidence suggests that TEP is superior to open repair in reducing wound infection、chronic pain and speeding the recovery, but the operation time of TEP is lonnger and the cost is much higher; There is no significant difference in recurrence rate and postoperative complications between the two methods.