Purposes <p>Owing to the lack of a standardized surgical approach, surgical treatment of patients with chronic postoperative inguinal pain remains challenging. The aim of the present study was to evaluate the safety and long-term efficacy of surgical intervention in patients with chronic postoperative inguinal pain based on the patient-reported outcome measures.</p> Methods <p>Fifty-four patients who underwent surgery for chronic postoperative inguinal pain at two institutions between March 2013 and July 2024 were retrospectively evaluated. The surgical procedure was selected according to the type of pain and primary hernia repair procedure. Safety was assessed by early postoperative morbidity, and long-term efficacy was evaluated by a questionnaire survey regarding postsurgical satisfaction (excellent/good/moderate/poor), hernia recurrence, and change in the pain scale score.</p> Results <p>At a median follow-up of 35.3 months, 92% of patients reported “excellent” or “good” satisfaction with the results. The mean NRS score significantly decreased from 7.7 before surgery to 2.5 after surgery (<i>P</i> &lt; 0.001). Severe morbidity and hernia recurrence occurred in 5.6% (3/54) and 3.7% (2/54) of patients, respectively.</p> Conclusions <p>This study proposes a surgical strategy for patients with CPIP based on the primary repair method and pain type. Although further validation is needed, our algorithm yielded a high degree of patient satisfaction.</p>