To evaluate the efficacy of laparoscopic totally extra-peritoneal hernia repair (TEP), trans-abdominal preperitoneal hernia repair (TAPP) and open hernia repair in the treatment of indirect inguinal hernia.

90 patients with indirect inguinal hernia who were treated in Taicang Traditional Chinese Medicine Hospital from January 2019 to December 2021 were selected as the study subjects. All patients were divided into three groups according to different surgical methods, including open group (n=30), TAPP group (n=30), and TEP group (n=30). The operation related indexes (operation time, blood loss, time to get out of bed after operation, anus exhaust time, and total medical expenses) of the three groups were compared. The pain severity [visual analog scale (VAS)] of patients in the three groups was compared at 6, 24 h and 1 month after operation. The serum stress response indexes [noradrenaline (NE), adrenaline, adrenergic rash stimulating hormone (ACTH), cortisol] of the three groups were compared before and 48 hours after operation. The complication indicators (urinary retention, flatulence, intestinal obstruction, seroma, chronic pain) of the three groups were compared within 6 months after surgery.

The differences of blood loss, time of getting out of bed after operation, anal exhaust time of the three groups were statistically significant (P<0.05), and TAPP group and TEP group were better than open group. The operation time and total medical expenses of the open group were better than those of the TAPP group and the TEP group. The time to get out of bed after operation and total medical expenses in TEP group were significantly better than those in TAPP group (P<0.05). There was a statistically significant difference in the pain scores of the three groups at 6 h and 24 h after operation (P<0.05), and TAPP group and TEP group were better than open group. The pain score of TEP group was better than that of TAPP group at 6 hours after operation (P<0.05). There was no statistically significant difference in the pain scores among the three groups at 1 month after operation (P>0.05). There was no significant difference in the level of NE, adrenaline, ACTH and cortisol among the three groups before operation (P>0.05). At 48 h after operation, the level of NE, adrenaline, ACTH and cortisol in the three groups were statistically significant (P<0.05), and the levels in TAPP group and TEP group were lower than those in open group. At 48 h after operation, the level of NE and cortisol in TEP group was lower than those in the TAPP group (P<0.05). The difference of complication data within 6 months after operation among the three groups was statistically significant (P<0.05). The incidence of complications in TAPP group and TEP group was significantly lower than that in open group. There was no significant difference between TAPP group and TEP group.

In the treatment of patients with inguinal hernia, TAPP, TEP and open surgery have their own advantages, clinical selection should be made according to the patient's condition.