Laparoscopic-enhanced recovery after surgery protocol for incarcerated inguinal hernia: a paradigm shift toward precision emergency herniology.

Objective: To evaluate the safety and efficacy of a modified Enhanced Recovery After Surgery (ERAS) protocol integrated with laparoscopic repair for incarcerated inguinal hernia, comparing outcomes with conventional open surgery.

Methods: This single-center retrospective cohort study (2019-2024) included 200 patients with incarcerated inguinal hernia. These patients were assigned to the laparoscopy group or the open group (in a 1:1 ratio). Propensity score matching (PSM) balanced the baseline characteristics. ERAS intervention includes preoperative counseling, multimodal analgesia and forced early activities. Continuous variable: Independent -test or Mann-Whitney U; Categorical variables: Chi-square test or fish test; Multivariate logistic regression was used for hazard ratio analysis.

Results: After PSM (80 pairs), the laparoscopic group demonstrated significantly lower overall complications (9% vs. 38%,  = 0.007), including reduced surgical site infections (6% vs. 18%) and postoperative ileus (4% vs. 14%). Laparoscopy shortened hospital stays (3.1 vs. 5.6 days,  < 0.001), accelerated bowel function recovery (16.5 vs. 26.3 h,  < 0.001), and decreased opioid use (12.4 vs. 32.7 mg,  < 0.001). Eighteen cases required open conversion (15 for intestinal resection). No large bowel resections occurred.

Conclusion: Laparoscopic repair of incarcerated inguinal hernias integrated with ERAS protocols demonstrates significant clinical efficacy, effectively reducing postoperative complications and accelerating recovery, thereby establishing itself as a recommended standard for widespread clinical adoption.