Objective: To evaluate the efficacy of modified Kugel patch repair for inguinal hernia in elderly patients. Methods: The clinical and follow-up data of 386 elderly patients over 60 years of age with inguinal hernia undergoing modified Kugel repair from February 2006 to June 2013 were retrospectively analyzed. Results: The operation was successfully performed in all patients. The operative time was 32-95 min, intraoperative blood loss was 50-150 mL in 6 cases and was less than 30 mL in all the remaining cases, time to first ambulation was 7-16 h, and length of postoperative hospital stay was 5-18 d. No surgical death and no cases of orchitis, seroma or scrotal hematoma occurred. Postoperative wound disruption, surgical site infection and lower-extremity deep venous thrombosis developed in one case (0.25%) each, 3 cases (0.78%) had moderate chronic pain and 46 cases (11.9%) had stretching pain in the operative area during walking for two weeks after operation. Follow-up of 3-65 months was obtained in 349 patients, and no postoperative recurrence was noted. Conclusion: Modified Kugel repair for inguinal hernia in elderly patients is safe and effective, and using high-quality patch with appropriate patch placement and fixation as well as sufficient and effective drainage of the surgical area, can promote the postoperative recovery of the patients.