Purpose: Long-term (3-5 years) results following inguinal hernia repair in a large series of patients using a novel technique-the ONSTEP approach-are presented. In particular, the recurrence rate, long-term complications and patient satisfaction with the procedure are discussed. Methods:Adult patients underwent ONSTEP inguinal hernia repair using a PolySoft™ hernia patch. All procedures were performed by one of two surgeons. Patients were followed up for 3-5 years for recurrences and complications, including chronic and residual pain. Patients were also asked to rate their satisfaction with the procedure.Results: Data were available from 398 hernia repair procedures in 314 patients at the 3-5-year follow-up. The overall recurrence rate was 2.0% (8/398). Additionally, there were 14 cases (3.5%; 14/398) of residual pain and 5 cases (1.3%; 5/398) of wound infection. No patients experienced chronic pain and there were no cases of mesh infection. Patient satisfaction with the ONSTEP procedure was high, with 94.9% of patients rating it as excellent, very good or good.Conclusions: ONSTEP inguinal hernia repair produced consistent results in the long term, and was associated with a low recurrence rate, only minor complications and no chronic pain. The procedure offers an alternative approach to both Lichtenstein and laparoscopic repair.