Objective: to optimize the differential choice between laparoscopic and open alloplastic repair for incarcerated inguinal hernias by analyzing the effectiveness of both approaches, their impact on postoperative complications, hospital stay duration, and recovery speed. Materials and Methods. The study included 118 patients aged 30–75 years, divided into two groups: the main group (n=58) and the comparison group (n=60). In the main group, diagnostic laparoscopy was used to assess the viability of the incarcerated organ and determine the optimal surgical approach. If no necrotic changes were found, transabdominal preperitoneal (TAPP) repair was performed, while in cases of necrosis, laparotomy with bowel resection and Lichtenstein alloplastic repair was conducted. The comparison group underwent only open surgery without prior laparoscopy. Results. The laparoscopic approach significantly reduced the incidence of postoperative complications, including seroma (2.3% vs. 16.7% in the open surgery group) and infection (0% vs. 6.2%). The intensity of acute postoperative pain was lower in the laparoscopic group (median of 3 points on the VAS scale vs. 6 points in the open surgery group). Patients who underwent laparoscopic surgery had shorter hospital stays (2–4 days vs. 6–8 days) and returned to physical activity sooner (6–12 days vs. 13–31 days). Conclusions. Performing diagnostic laparoscopy for incarcerated inguinal hernias allows for an objective assessment of the incarcerated organ’s condition and the selection of the most appropriate surgical technique. The TAPP laparoscopic technique is an effective alternative to open hernioplasty, as it reduces complications, improves postoperative comfort, and shortens the recovery period.