Since Kocher advocated aligning surgical incisions with Langer’s lines in 1892, various skin lines and incisions in accordance have been described. All of them has their own advantages and disadvantages. The choice of surgical incision in open inguinal hernia repair is determined by access, re-establishment of soft tissue function and structural support with most natural aesthetic appearance and minimal distortion after healing. This study compares the outcomes of transverse incision (along Langer’s lines) and oblique incision (traditional incision parallel to inguinal ligament) in open inguinal hernia repair, a common surgery in India. Seventy-four patients aged 18 to 70 years were equally divided into two groups. Group 1 underwent oblique incisions, and Group 2 underwent transverse incisions. Parameters measured included operative time, postoperative pain (VAS scores), patient satisfaction (POSAS v2.0), and complication rates. Median operative time was shorter for the oblique group compared to the transverse group. Transverse incisions had better cosmetic outcomes and similar complication rates. Postoperative pain was comparable between groups. Transverse incision offers superior scar appearance, whereas oblique incision saves operative time. Incision choice should consider patient concerns and surgical familiarity.