对比腹腔镜经腹腹膜前疝修补术（TAPP）中分离钳冷分离与电钩热分离处理疝囊的围手术期指标、术后疼痛及安全性。

采用单中心回顾性研究，纳入2024年1月至2025年5月在蒙城县第一人民医院行TAPP术的170例单侧男性腹股沟斜疝患者，根据腹膜前间隙分离技术迭代的先后时段分组：对照组（85例）为技术应用早期，采用电钩热分离；观察组（85例）为技术优化后阶段，采用分离钳冷分离。比较2组患者围手术期指标，术后12、24、48 h视觉模拟评分法（VAS）疼痛评分，以及术后14 d并发症发生情况。采用倾向性评分匹配（PSM）与多因素回归控制混杂因素，术后随访3个月评估短期预后。

2组患者年龄、病程、体重指数、疝囊大小、粘连程度比较，差异无统计学意义（P>0.05）。观察组手术时间、疝囊处理时间短于对照组，术中出血量、术后腹股沟积液量高于对照组，差异有统计学意义（P<0.001）；住院时间比较，差异无统计学意义（P>0.05）。2组患者术后各时间点VAS评分比较，差异无统计学意义（P>0.05）。观察组术后14 d并发症总发生率5.9%，低于对照组15.3%（P=0.046），对照组出现热相关严重并发症。3个月随访无失访，无疝复发及迟发严重并发症。

TAPP术中分离钳冷分离可缩短手术时间、降低围手术期并发症风险，仅伴一过性腹股沟积液；电钩热分离止血直接但存在热损伤风险。临床应根据疝囊情况个体化选择或联合两种技术。

To compare perioperative outcomes, postoperative pain, and safety between cold dissection with dissecting forceps and thermal dissection with an electrosurgical hook for hernia sac management during laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair.

This single-center retrospective study included 170 male patients with unilateral indirect inguinal hernias who underwent TAPP repair at Mengcheng County First People's Hospital between January 2024 and May 2025. Patients were divided into two groups according to the chronological implementation of different preperitoneal dissection techniques. The control group (n=85), treated during the initial period, underwent thermal dissection with an electrosurgical hook, whereas the observation group (n=85), treated after technical optimization, underwent cold dissection with dissecting forceps. Perioperative parameters, visual analog scale (VAS) pain scores at 12, 24, and 48 hours postoperatively, and the incidence of complications within 14 days after surgery were compared between the two groups. Propensity score matching (PSM) and multivariable regression analysis were used to control for potential confounding factors. Patients were followed up for 3 months to assess short-term outcomes.

No statistically significant differences were observed between the two groups in age, disease duration, body mass index, hernia sac size, or severity of adhesions (all P>0.05). The operative time and hernia sac dissection time were significantly shorter in the observation group than in the control group, whereas intraoperative blood loss and postoperative inguinal fluid collection volume were significantly greater in the observation group (all P<0.001). There was no statistically significant difference in the length of hospital stay between the two groups (P>0.05). No statistically significant differences were observed in VAS pain scores at any postoperative assessment time point between the two groups (all P>0.05). The overall incidence of complications within 14 days after surgery was significantly lower in the observation group than in the control group (5.9% vs. 15.3%, P=0.046). Severe thermal injury-related complications occurred in the control group. No patients were lost to follow-up during the 3-month follow-up period, and no hernia recurrence or delayed severe complications were observed.

Cold dissection with dissecting forceps during TAPP repair can shorten operative time and reduce the risk of perioperative complications, although it may be accompanied by transient postoperative inguinal fluid collections. Thermal dissection with an electrosurgical hook provides direct hemostasis but carries a risk of thermal injury. The two techniques should be selected individually or used in combination according to the characteristics of the hernia sac.