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.