Objective To investigate the effect of unidirectional barbed suture in transabdominal preperitoneal prosthetic (TAPP) laparoscopic hernioplasty in the elderly patients. Methods A retrospective analysis was made of the clinical data of 120 elderly patients undergoing TAPP from November 2016 to June 2019 in the General Surgery Department of the Third Affiliated Hospital of Inner Mongolia Medical University. Unidirectional barbed suture was used in half of them (n=60) and Vicryl suture in the other half (n=60). The two groups were compared in baseline data, the suturing time, operation time, intraoperative bleeding volume, hospital stay, visual analogue scale (VAS) of pain on the first day after operation, and postoperative complications. The data was processed using SPSS statistics 20.0. Depending on data type, comparison was made using t-test or χ² test. Results There was no significant difference in baseline data, intraoperative bleeding volume, hospital stay, VAS score of pain on the first day after operation, and postoperative complications between the two groups (P＞0.05). Unidirectional barbed suture group had shorter suturing time [(10.4±1.6) vs (15.4±4.8)min] and operation time [(53.8±4.6) vs (66.2±5.4)min] than Vicryl suture group, the differences being statistically significant (P<0.05). Conclusion Continuous suture of peritoneum with unidirectional barbed suture in TAPP simplifies the operation and shortens the operation time, which is of great significance to the elderly patients and is worthy of clinical application.