Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide. The introduction of prosthetic mesh has significantly reduced recurrence rates; however, chronic postoperative inguinal pain remains an important concern. Mesh fixation is a critical component of hernia repair, influencing mesh stability, recurrence, postoperative pain, procedural costs, and patient recovery. Researchers have developed various fixation techniques, including sutures, staples, tacks, fibrin glue, cyanoacrylate glue, self-gripping meshes, and non-fixation approaches. Current evidence suggests that atraumatic fixation methods may reduce postoperative and chronic pain while maintaining recurrence rates comparable to conventional mechanical fixation. Recent systematic reviews and international guidelines support selective rather than routine mesh fixation in many laparoscopic repairs, particularly in small to medium-sized defects. This review discusses current mesh fixation techniques in open and laparoscopic inguinal hernia repair, evaluates their advantages and disadvantages, and examines contemporary evidence regarding clinical outcomes.