AIM: Inguinal hernia repair is among the most common surgical procedures worldwide, and the approach is evolving towards minimally invasive techniques such as laparoscopic transabdominal preperitoneal (TAPP) repair. However, open tension-free repairs remain essential in specific clinical contexts. This study aimed to compare perioperative outcomes, postoperative recovery, complication rates, and medical costs between small-incision tension-free mesh repair combined with scrotal drainage and laparoscopic TAPP repair, providing evidence-based guidance for surgical selection in diverse practice environments.

METHODS: A retrospective cohort study was conducted at Yanbian University Hospital between June 2018 and February 2023. A total of 323 consecutive patients were enrolled. Group A included 107 patients who underwent small-incision tension-free mesh repair combined with scrotal drainage, and Group B included 216 patients who underwent TAPP. Baseline demographics were compared to ensure group equivalence. Intraoperative parameters (blood loss, operative time), postoperative recovery indicators (time to first flatus, ambulation initiation, pain resolution), length of hospital stay, medical costs, complication rates, and recurrence within six months were assessed using appropriate statistical tests (p < 0.05 indicated significance).

RESULTS: No significant differences in baseline characteristics were detected between the two groups (p > 0.05). Compared with TAPP (Group B), small-incision tension-free mesh repair with scrotal drainage (Group A) was associated with greater intraoperative blood loss (p < 0.001) but a shorter operative time (p < 0.001). Postoperatively, Group A had longer hospital stays and delayed recovery of gastrointestinal function (time to first flatus), ambulation, and pain resolution (all p < 0.001). Total hospitalization costs were significantly lower in Group A than in Group B (p < 0.001). The mean duration of drain placement in Group A was 2.03 ± 0.65 days. Chronic groin pain occurred in 8.4% vs. 4.6% (p > 0.05) of patients, and hernia recurrence rates were 1.9% vs. 1.4% (p > 0.05) for Groups A and B, respectively. Incisional infection was more frequent in Group A (3.7%) than in Group B (0%, p < 0.05).

CONCLUSIONS: Both small-incision tension-free mesh repair with scrotal drainage and TAPP are safe and effective when performed by experienced surgeons within standardized perioperative protocols. The small-incision approach is particularly suitable for elderly patients and those with comorbidities limiting tolerance to general anaesthesia, as well as for resource-constrained settings. Targeted drain placement effectively prevents postoperative seroma formation but may also increase local tissue trauma, prolong postoperative discomfort, delay mobilization, and increase the risk of superficial wound infection.