Objective: To evaluate the clinical efficacy and safety of prophylactic ilioinguinal neurectomy in open tension-free inguinal hernia repair. Methods: The randomized controlled trials estimating the clinical significance of prophylactic ilioinguinal neurectomy publically published before March 2017 were searched in several national and international databases. A meta-analysis was performed on the extracted data. Results: A total of 13 studies were included, involving 2 033 patients with 1 007 cases in nerve excision group and 1 026 cases in nerve preservation group. In nerve excision group compared nerve preservation group, the short- and mid-term postoperative pain (SMD=–0.54, 95% CI=–0.85––0.23; SMD=–0.25, 95% CI=–0.40––0.10) were significantly reduced (both P<0.05), but the long-term postoperative pain (SMD=–0.21, 95% CI=–0.47–0.05) showed no significant difference (P>0.05); all the short-, mid- and long-term rates of postoperative numbness (RD=0.00, 95% CI=–0.06 0.07; RD=0.01, 95% CI=–0.03 0.06; RD=0.00, 95% CI=–0.03–0.02) and sensory disturbance (RD=0.05, 95% CI=–0.03–0.12; RD=0.02, 95% CI=–0.02–0.06; RD=0.01, 95% CI=–0.02–0.04) showed no significant difference (all P>0.05); the incidence of minor postoperative complications (RR=0.71, 95% CI=0.48–1.06) also showed no significant difference (P>0.05). Conclusion: Prophylactic ilioinguinal neurectomy in open inguinal hernia repair can effectively reduce the short- and mid-term pain, with no increase of risk of abnormal sensations in the inguinal area.