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Most patients are candidates for a non-mesh inguinal hernia repair, as long as they are aware of the associated risks.
A hernia recurrence is the is the most common risk. It shouldn’t be taken lightly. A redo hernia repair will always provide a worse outcome than a primary repair. Also, often the recurrence can be larger than the first hernia, as it is due to a tear, and so repair will be more difficult and in the setting of less healthy tissue.
Nerve injury is another risk. When sewing the tissue repair, all three nerves are at risk of injury and/or entrapment, resulting in neuropathic pain. That can be tricky to treat.
Chronic pain has always been a risk for tissue repair. It was not as well studied back in the day, as we are doing now, because recurrence was a bigger problem. That said, it’s false to believe that chronic pain is not a risk with non-mesh tissue repair. The chronic pain is due to tight repair (it is not a tension free repair), nerve entrapment, and possible pubic bone related pain.
As with any repair, the more the experience of your surgeon with that type of repair, the lower the risk of these complications.