Background: Enhanced recovery after surgery (ERAS) protocol is an effective evidence-based multidisciplinary protocol to optimize the postsurgical recovery process through perioperative interventions. The aim of the present study was to evaluate the effects of ERAS program on operation-related indicators, complications, pain, and quality of life in patients older than 60 years undergoing the transabdominal preperitoneal (TAPP) approach. Methods: This was a retrospective study of prospectively collected data from a single institution. A total of 160 elderly patients who underwent TAPP were divided into two groups: 80 patients in the ERAS group from January 2019 to December 2020, and 80 patients in the non-ERAS group from January 2021 to December 2022 in the non-ERAS group, and the groups were managed with the ERAS protocol and conventional management, respectively. We compared differences in operation-related indicators, complications, pain, and quality of life between the two groups. Results: Operation-related indicators (exhaust time, postoperative eating time, time to first ambulation, hospitalization cost, and postoperative hospital stay) and early postoperative pain of the ERAS group were superior to those of the non-ERAS group, and the difference had statistical significance (P < .05). More importantly, our results demonstrated that compared with the non-ERAS group, the application of ERAS in inguinal hernia patients may reduce postoperative complications (urinary retention, chronic pain) and improve quality of life. Conclusion: The ERAS program might provide the efficiency and safety approach to optimize clinical outcomes in the elderly patients older than 60 years undergoing TAPP approach.