The aim of the study. To support a tailored inguinal hernia repair, we developed a score system based on anamnestic risk factors for recurrence.Material and methods. We used the HEAD-Score in a county hospital and suggested mesh repair in scores of 15 or greater. Patients were followed in a prospective study for 2 weeks and 12 months.Results. We used mesh repair in 61.5% of the 281 inguinal hernia repairs. In mesh repair, we observed significantly more seroma formation (48.5% vs 20.4%). We found only two recurrences after Lichtenstein repair. In the Shouldice group, two patients underwent re-operation due to an ilioinguinal entrapment syndrome.Conclusions. Tailored inguinal hernia repair with the help of the HEAD-Score is possible and leads to acceptable complication rates and a low recurrence rate (0.9%) after one year. The risk of mesh-depended complications can be reduced with this approach.