Purpose <p>Metachronous contralateral inguinal hernia (MCIH) following unilateral inguinal hernia repair is a common cause of reoperation. Contralateral occult inguinal hernia (OIH) may cause MCIH. Transabdominal preperitoneal hernioplasty (TAPP) might be overtreatment for OIH repair; laparoscopic iliopubic tract repair (IPTR) may be an effective alternative but has not been robustly studied. We compared laparoscopic IPTR and TAPP in treating OIH.</p> Methods <p>This retrospective observational cohort study included 701 patients aged ≥ 18 years who received treatment for inguinal hernia between September 2012 and December 2023; 90 patients were excluded owing to loss during follow-up. Patients were divided into TAPP (54 patients; mesh implantation) and laparoscopic IPTR (647 patients; suture of the iliopubic tract and transversalis fascia arch without mesh implantation) groups.</p> Results <p>MCIH from repaired OIH occurred in one patient in the TAPP group and six patients in the IPTR group [1.9% (1/54) vs. 0.9% (6/647), respectively]; this difference was not significant. The postoperative complication rate was higher in the TAPP group than in the IPTR group [5.6% (3/54) vs. 0.8% (5/647), <i>p</i> &lt; 0.001]. Inguinodynia occurred in one patient in each group. Postoperative pain scores, duration of hospitalization, and time to return to normal daily life did not differ significantly between groups.</p> Conclusion <p>Laparoscopic IPTR is safe and effective for treating OIH and presents a viable alternative to TAPP.</p>