Objective To investigate the effect of laparoscopic transperitoneal preperitoneal hernia repair （TAPP） on elderly inguinal hernia. Methods A total of 100 elderly patients with inguinal hernia admitted to the First Hospital of Sanming City affiliated to Fujian Medical University from January 2022 to September 2023 were selected as study participants, and were divided into an observation group and a control group according to the surgical method, with 50 cases in each group. The control group received open tension-free hernia repair, and the observation group received TAPP treatment. The effects of the two groups were compared and analyzed. Results The operation time in the observation group was significantly longer than that in the control group （P<0.05）. The amount of bleeding in the observation group was significantly less than that in the control group （P<0.05）. The gastrointestinal recovery time and hospital stay in the observation group were significantly shorter than those in the control group （P<0.05）. Before operation, there was no significant difference in visual analogue scale （VAS） score between the two groups （P>0.05）. After operation, the VAS scores at different time points in the observation group were significantly lower than those in the control group （P<0.05）. There was no significant difference in the 36-Item Short Form Health Survey （SF-36） score between the two groups before operation （P>0.05）. After operation, the SF-36 scores in both groups were significantly increased than those before operation （P<0.05）, and the SF-36 score in the observation group was significantly higher than that in the control group （P<0.05）. The incidence of complications in the observation group was significantly lower than that in the control group （P<0.05）, but there was no significant difference in recurrence rate between the two groups （P>0.05）. Conclusion TAPP is safe and effective in the treatment of elderly inguinal hernia, and worthy of promotion.