In the last 15 years, a rapid evolution occurred from the traditional hernioplasties toward prosthetic techniques, in Italy. Outpatient procedures under local anaesthesia are now most commonly performed. We report our experience with a personal modification of the sutureless mesh repair, called "held in mesh repair". From 1990 to 2003 we treated 3,520 cases of primary hernia with the "held in mesh repair". 2,370 patients were affected by a unilateral hernia and 575 by a bilateral one. Local anaesthesia was used in 92% of the cases, loco-regional in 6% and general in 2%. Sixteen (0.4%) hernias recurred after 2 years, while two further recurrences (total 0.5%) were observed after 3 years; three femoral pseudo-relapses (0.08%) occurred before the first postoperative year. An overall incidence of 1.3% of major complications were observed. One mortality case (0.02%) occurred 3 days after the operation for cardiovascular complications. The favourable results of the "held in mesh repair" and the simplicity of the procedure suggest that it can be considered a safe and reliable technique for most primary inguinal hernias.