To investigate the short-term efficacy and safety of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) and Lichtenstein's tension-free hernia repair (Lichtenstein) in the treatment of bilateral primary inguinal hernias in adult males.

A total of 108 adult male patients with bilateral primary inguinal hernia in The Second Hospital of Hebei Medical University from May 2021 to March 2024 were selected as the study subjects. According to the treatment regimens, patients were grouped and selected using a 1:1 matching method. The 54 patients who were treated with the Lichtenstein procedure were included in the Lichtenstein group, and the 54 patients who were treated with the TAPP procedure were included in the TAPP group. The perioperative indicators and postoperative complications were compared between the two groups, as well as the stress hormone levels [cortisol (Cor), norepinephrine (NE), acetylcholine (ACH)] before surgery and 1 day before discharge, the serum testosterone and sperm quality before and 3 months after surgery, the scores of International Index of Erectile Function -5 (IIEF-5), the Chinese Premature Ejaculation Questionnaire (CIPE), and the inguinal pain questionnaire (IPQ) before and 3 months after surgery. The recurrence rate at 1 year after surgery was analyzed.

The postoperative 24-hour numerical rating scale (NRS) score in TAPP group was (3.27±0.52) points, which was lower than that in Lichtenstein group (6.69±1.27) points, the postoperative ambulation time, exhaust time and hospitalization time were (15.37±2.69) h, (19.64±3.26) h and (3.69±0.87) d, respectively, which were shorter than those in Lichtenstein group (24.11±5.02) h, (26.87±5.51) h and (5.34±1.12) d, the cost of treatment (1.82±0.25) ten thousand yuan was higher than that of Lichtenstein group (1.36±0.19) ten thousand yuan (P<0.05). The levels of serum NE, ACH and Cor in TAPP group 1 day before discharge were (4.52±0.78) μg/L, (25.44±2.17) pg/ml and (598.41±37.24) mmol/L, respectively, which were lower than those in Lichtenstein group [(5.11±0.82) μg/L, (28.63±2.27) pg/ml, (624.11±40.11) mmol/L], and the difference was not statistically significant (P>0.05). The operation time, postoperative complications and recurrence rate within 1 year after operation in TAPP group were (91.27±18.73) min, 9.26% and 1.85%, respectively, which were not significantly different from those in Lichtenstein group (91.27±18.73) min, 12.96% and 3.70% (P>0.05). There were no significant differences in serum testosterone, sperm concentration, total sperm motility, sperm malformation rate, IIEF-5 score, CIPE score, and IPQ score before surgery and three months after surgery, as well as between the two groups (P>0.05).

Both the Lichtenstein procedure and the TAPP procedure have demonstrated good efficacy in treating bilateral inguinal hernias in adult males, and neither procedure has any impact on the patient's reproductive system. The TAPP procedure has advantages in reducing stress response, alleviating pain, and facilitating rapid postoperative recovery. However, its hospitalization costs are relatively high. Clinically, appropriate surgical procedures can be selected based on the patient's condition.