To observe the clinical efficacy and safety of laparoscopic preperitoneal hernia repair (TAPP) in the treatment of elderly patients with acute incarcerated inguinal hernia.

This retrospective controlled clinical study included 80 elderly patients with acute incarcerated inguinal hernia who were admitted to the Department of Emergency Medicine, Lianyungang Hospital of Jiangsu Provincial Hospital of Traditional Chinese Medicine, from April 2022 to June 2025. The surgical approach was determined by the physician in charge based on a comprehensive assessment of each patient's clinical condition, and informed consent was obtained from all patients. According to the surgical approach, the patients were divided into the control group, which underwent conventional open tension-free hernia repair (n=38), and the experimental group, which underwent TAPP (n=42). Surgical-related indicators, early postoperative pain scores, stress indicators, gastrointestinal function recovery, intestinal mucosal barrier function indicators, and postoperative complications were compared between the two groups.

Both groups of patients successfully underwent surgery and completed the 3-month follow-up and no drop-out cases were found. The operation time, the time of the first postoperative ambulation, and the postoperative hospital stay in the experimental group were all shorter than those in the control group, and the differences were statistically significant (P<0.05). The visual analogue scale scores for pain in the experimental group on the 1st day, 1st week, and 3rd month after surgery were lower than those in the control group, and the differences were statistically significant (F=0.816, P=0.041). On the 1st day after surgery, the levels of substance P and neuropeptide Y in both groups decreased significantly compared to those before the operation, and the levels in the experimental group were lower, with statistically significant differences (P<0.05). The first defecation time and the recovery time of bowel sounds in the experimental group were better than those in the control group, and the differences were statistically significant (P<0.05). The levels of epinephrine, cortisol, and serum malondialdehyde in both groups significantly increased on the 1st day after surgery, but the levels in the experimental group were lower than those in the control group, with statistically significant differences (P<0.05). The levels of diamine oxidase and serum D-lactic acid in both groups significantly decreased on the 1st day after surgery, and the levels in the experimental group were lower than those in the control group, with statistically significant differences (P<0.05). There were no cases of partial intestinal obstruction or recurrence of hernia in both groups. The complication and recurrence rates between groups were 11.90% (5/42) and 7.89% (3/38), there was no statistically significant difference (Fisher's exact test, P=0.715).

Compared with conventional open surgery, TAPP is superior in alleviating early postoperative pain and stress response and promoting gastrointestinal function recovery in elderly patients with acute incarcerated inguinal hernia, while providing comparable safety.