Background: Totally Extra Peritoneal (TEP) Approach in strengthening of posterior wall defect by placing a prosthetic mesh by a posterior approach is commonly practiced for hernia repair. There was a paucity of literature on the long term analysis of outcomes using heavy weight and light weight meshes. Objective: To compare the outcomes in endoscopic total extra-peritoneal groin hernia repair using lightweight and heavyweight polypropylene mesh. Materials and Methods: It was a hospital based prospective randomized clinical trial conducted among 66 patients over a period of 5 years to compare the outcomes of patients following laparoscopic total extra-peritoneal technique of tension free groin hernia repair using standard heavyweight (Prolene®) and lightweight (Ultrapro®) mesh prosthesis. A total of 32 participants were included in heavyweight mesh group and 34 in lightweight mesh group. All patients were randomly divided into two groups by computer generated random number tables. The study participants were followed for a period of 5 years to assess occurrence of chronic groin pain, recurrence, operative time, postoperative pain on days 0, 1 and 7 (VAS scores), return to normal daily activities, testicular pain and seroma formation. Results: The mean age + SD of study participants in lightweight meshgroup was 54.14 ± 8.33 yrs while it was 54.84 ± 6.75 yrs in heavyweight meshgroup and all study participants were males except one. The average time for return to normal daily activities was 2.35 days in lightweight meshgroup while it was 3.12 days in heavyweight meshgroup (p value =0.01). Post operative pain on day 7and chronic groin pain was statistically significantly lower in lightweight mesh group than heavyweight meshgroup (p value<0.01). Conclusion: The use of lightweight mesh for groin hernia repair is a safe and viable option. It offers many advantages in terms of decreased chronic groin pain and decreased post operative morbidity
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