Objective To evaluate methods of OP mesh spreading in preperitoneal tension-free repair of inguinal hernia via open anterior approach.Methods The clinical data of 1 528 cases underwent preperitoneal tension-free repair of inguinal hernia via open anterior approach from March 2012 to April 2015 was analyzed retrospectively.The methods of mesh crimp spreading, pectineal ligament suture fixation, pubic tubercle suture fixation and auxiliary support were used.Results The mesh crimp spreading method was used in 1 021 cases, pectineal ligament suture fixation method was used in 64 cases, pubic tubercle suture fixation method was used in 48 cases, auxiliary support method was used in 395 cases.Meshes were all well spreaded.Conclusions The four methods of mesh spreading are effective, simple, convenient and easy to use in preperitoneal tension-free repair of inguinal hernia via open anterior approach.