Purpose: Despite the historical preference for open repair over laparoscopic repair for acutely strangulated and incarcerated groin hernias, literature investigating the optimal approach is limited. This review explores the safety and clinical outcomes of laparoscopic and open groin hernia repair in the emergency setting. Methodology: PubMed, Embase, Scopus, Cochrane Library, and Web of Science were systematically searched for articles comparing outcomes between laparoscopic and open emergency groin hernia repair in adult patients. Primary outcomes included operative time, length of hospital stay, post-operative complications, recurrence, and reoperation. Secondary outcomes were post-operative mortality and the rate of conversion from laparoscopic to open repair. Results: Thirteen articles with 40,199 patients were included. Laparoscopic repair resulted in shorter length of hospital stay (MD -2.23 days [95% CI -4.17 -0.28], p = 0.0324), reduced risk of wound infection (RR 0.29 [95% CI 0.18, 0.45], p = 0.0003], and lower reoperation rate (RR 0.663 [95% CI 0.46, 0.95], p = 0.0368). No statistically significant differences were observed in operative time (p = 0.2720), seroma formation (p = 0.3142), respiratory complications (p = 0.9880), and recurrence (p = 0.0559). In-hospital mortality ranged from 1.88% to 2.20% for open repair and 0% to 1.41% for laparoscopic repair. Conversion from laparoscopic to open repair occurred in 3.76% of patients ([95% CI 0.29, 34.11]). Conclusion: Emergency laparoscopic repair of groin hernias results in shorter hospital stay and reduced post-operative morbidity, with comparable operative time to open repair. It appears to be a safe and feasible alternative to open repair in the acute setting.