Abstract：Objective To explore the effects of laparoscopic transabdominal preperitoneal hernia repair（TAPP） and mesh plug-flat hernia repair on the pain degree and prognosis of elderly patients with inguinal hernia. Methods A total of 78 elderly patients with inguinal hernia admitted to our hospital from March 2018 to October 2022 were randomly divided into the control group and the observation group, with 39 cases in each group. The control group underwent mesh plug-flat hernia repair, while the observation group underwent laparoscopic TAPP. Surgical outcomes, pain levels, spermatic vein diameter, spermatic vein blood flow velocity, complication rates, and recurrence rates were compared between the two groups. Results The observation group showed better outcomes in terms of surgery duration, intraoperative blood loss, time to postoperative mobilization, time to first flatus, time to normal activity, and length of hospital stay; however, hospital costs were higher compared to the control group. Postoperative pain scores at different time intervals were lower in the observation group, and improvements in spermatic vein diameter and blood flow velocity were also better compared to the control group, with statistically significant differences in all comparisons （t＝11.103, 22.227, 7.899, 7.788, 3.054, 4.175, 35.367, 4.329, 3.849, 7.861, 7.353, 8.788, 3.630,  all P＜0.05）. The complication rate in the observation group was lower than in the control group, with a statistically significant difference （χ2＝3.924, P＜0.05）; however, there was no significant difference in the recurrence rates between the two groups （χ2＝1.103, P＞0.05）. Conclusion Laparoscopic TAPP in elderly patients with inguinal hernia can improve surgical outcomes, alleviate pain levels, and enhance prognosis.