Objective To evaluate the clinical efficacy of cruciate gear suture (CGS) for pseudo hernia sac management in laparoscopic transabdominal preperitoneal (TAPP) repair.

Methods The prospective randomized controlled study was conducted. The clinical data of 82 patients with primary direct inguinal hernia who were admitted to Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital from April to December 2025 were selected. Patients underwent laparoscopic TAPP repair. Patients were randomly divided into the experimental group and the control group by the random number table.The pseudo⁃sac was closed with CGS in the experimental group and single‑hand four‑needle suture technique in the control group. Observation indicators: (1) grouping of enrolled patients; (2) surgical situations; (3) follow‑up. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann‑Whitney U test. Comparison of count data between groups was conducted using the chi‑square test or Fisher exact probability.

Results (1)Grouping of enrolled patients: a total of 82 patients with 107 pseudo hernia sacs eligible for primary direct inguinal hernia were selected. They were males, aged (64±11) years. All 82 patients were randomly divided into the experimental group (39 patients with 53 pseudo hernia sacs) and the control group (43 patients with 54 pseudo hernia sacs). There was no significant difference in age, height, weight, body mass index, hypertension, diabetes mellitus, direct hernia location, and maximum defect diameter between the two groups (P>0.05), indicating comparability. (2) Surgical situations: all patients in both groups underwent successful surgery. The pseudo‑sac management time was (184±45) seconds for the experimental group, versus (219±46) seconds for the control group, showing a significant difference between the two groups (t=-3.97, P<0.05). There was no significant difference in total operation time, 24 hours visual analog scale scores, postoperative hospital stay, hospital costs, Carolina comfort scale at postoperative week 1 between two groups (P>0.05). (3) Follow‑up: all patients were followed up for 6.3(3.9,8.4) months. During follow‑up, cases with surgical site discomfort lasting >30 days were 1 and 4 in the experimental group and control group, cases with postoperative seroma were 0 and 1, respectively, showing no significant difference between the two groups (P>0.05). No hernia recurrence was observed in either group.

Conclusion Application of CGS during laparoscopic TAPP repair for male patients with direct inguinal hernia is safe and effective, and significantly reduces the pseudo⁃sac management time.