Abstract: Objective：To explore the efficacy of preperitioneal tension-free hernia repair by lower abdominal median incision in incarcerated inguinal hernia．Methods：The clinical data of 126 patients with incarcerated hernia who underwent emergency operation from January 2010 to August 2016 were retrospectively analyzed. According to the surgical incision, they were divided into two groups: the observation group (41 cases) had the lower abdominal midline incision, and the control group (85 cases) had the traditional inguinal incision. The time of operation, the postoperative hospital stay, perioperative complications and the main long-term complication were compared between the two groups. Results：In the observation group (41 cases), 35 cases underwent preperitoneal tension-free repair (85.4%), 1 case recurred and was repaired again, and 2 cases underwent intestinal resection and anastomosis on account of intestinal necrosis. Of the 85 cases in the control group, 8 cases recurred and 7 cases underwent reoperation, 33 cases underwent first-stage tension-free repair and 1 cases was repaired again, and 3 cases underwent intestinal resection and anastomosis on account of intestinal necrosis. The rate of herniorrhaphy was significantly higher in the observation group than that in the control group (85.4% vs 38.8%，P<0.001). The total incidence of the main long-term complication of herniorrhaphy in observation group was lower than control group (5.7% vs 24.2%；P=0.031). The incidence of total surgical complications (including chronic pain, foreign body sensation, hernia recurrence, incision infection， and local serum swelling) in the observation group was lower than that in the control group (5.7% vs 24.2%, P=0.031). There was no significant differences between the two groups in terms of operation time, hospital stay, perioperative acute pain， and urinary retention. Conclusions：The tension-free repair of preperitoneal hernia through lower abdominal midline incision is simple and can improve the rate of first-stage tension-free repair of incarcerated hernia, and the complication rate is low. It is suitable for clinical application.