Inguinal hernia repair remains one of the most frequently performed operations worldwide. Although mesh-based techniques currently represent the standard of care in most adult patients, tissue-based repairs continue to play an important role in selected clinical situations, including contaminated surgical fields, resource-limited settings, and patient preference. Among the classical tissue repairs, Bassini repair and darning repair have maintained clinical relevance. Edoardo Bassini revolutionized hernia surgery in the late nineteenth century by introducing anatomical reconstruction of the posterior wall of the inguinal canal, significantly reducing recurrence rates compared with previous techniques. Darning repair, particularly the Moloney darn, was later developed as a tension-reducing tissue repair that employs nonabsorbable sutures to create a mesh-like support between the conjoint tendon and inguinal ligament. This review examines the indications, outcomes, advantages, disadvantages, and contemporary role of Bassini and darning repairs in adults with inguinal hernia. Current evidence suggests that while both techniques are effective in selected patients, darning repair generally demonstrates lower postoperative pain and tension, whereas Bassini repair provides a solid anatomical reconstruction but may be associated with higher recurrence rates when excessive tension is present. Despite the predominance of mesh repairs, both methods remain valuable components of the hernia surgeon's armamentarium.