The Lichtenstein hernia repair has become a popular technique for most inguinal hernias performed in the United States. One attempt to improve on this technique includes the use of a tacker instead of suturing the mesh. This study compared the feasibility and time saving for placement of mesh for open inguinal hernias with a tacker versus polypropylene suture. Thirty-four patients were prospectively randomized to undergo open hernia repair using either running 2-0 polypropylene suture or a tacker device that contained spiral titanium tacks. Patients were examined after 1week and followed for a mean of 8months (range 126months) to record postoperative complications and technical failure rate. Mesh placement times were significantly shorter in the tacker group (9.03.5min) than the suture group (30.99.9min). No technical complications or recurrences were found in the follow-up period in either group. Securing mesh with the tacker is safe, and repair appears durable at short-term follow-up. Using the tacker on open inguinal hernia repairs shortens the time for mesh placement compared to suture fixation. Decreased operative time may reduce overall cost.