Inguinal hernia repair is one of the most performed surgical procedures worldwide. The introduction of prosthetic mesh has significantly reduced recurrence rates and transformed the management of groin hernias. Among the various tension-free techniques developed, the mesh plug repair, popularized by Rutkow and Robbins in the 1990s, emerged as a simple and effective method that combines a conical polypropylene mesh plug inserted into the hernia defect with supplementary mesh reinforcement when necessary. The procedure gained widespread acceptance because of its technical simplicity, short operative time, low recurrence rates, and suitability for ambulatory surgery. However, concerns regarding mesh-related complications, including migration, chronic pain, erosion into adjacent organs, and foreign body sensation, have led to increasing scrutiny of the technique. Recent international hernia guidelines have increasingly favored flat mesh repairs and laparo-endoscopic approaches over mesh plugs. This review discusses the mesh plug repair, its clinical outcomes, advantages, limitations, complications, and contemporary role of mesh plug repair in inguinal hernia surgery. We also compare the mesh plug repair with the other open mesh inguinal hernia repairs and the laparoscopic inguinal hernia repairs.