Background For the repair of inguinal hernias, several surgical methods have been presented where the purpose is to place a mesh in the preperitoneal plane through an open access. The aim of this systematic review was to describe preperitoneal repairs with emphasis on the technique. Data sources A systematic review was conducted and reported according to the PRISMA statement. PubMed, Cochrane library and Embase were searched systematically. Studies were included if they provided clinical data with more than 30 days follow up following repair of an inguinal hernia with an open preperitoneal mesh technique. Conclusions A total of 67 articles were included, describing nine different methods: Kugel, TREPP, TIPP, Onstep, Horton/Florence, Nyhus, Ugahary, Read, and Stoppa. In general, results regarding pain, recurrences and complications seem promising. It was not possible to conduct a meta-analysis. Open preperitoneal techniques with placement of a mesh through an open approach seem promising compared with the standard anterior techniques. This systematic review provides an overview of these techniques together with a description of surgical methods and clinical outcomes.