Objective To investigate the effect of absorbable hemostatic gauze replacing polypropylene mesh plug on chronic pain and foreign body reaction after Rutkow. Methods After a propensity matching score, 741 patients with primary unilateral inguinal hernia underwent Rutkow were randomly divided into study group (371 cases) and control group (370 cases) from department of hernia and abdominal wall surgery of Naning Drum Tower Hospital and Gaochun People's Hospital from January 2017 to June 2018. The patching materials of the study group were polypropylene plain sheet and absorbable hemostatic gauze, while the control group was polypropylene plain sheet and mesh plug. The operative time, complications, chronic pain and foreign body reaction were analyzed. Results The levels of white blood cell count, percentage of neutrophils, serum cortisol (Cor), C-reactive protein (CRP), and interleukin-2 (IL-2) on the first day after operation of the two groups were higher than those in the preoperative period, and the levels of white blood cell count, Cor, CRP and IL-2 in the study group were lower than those in the control group, and the differences were statistically significant (P＜0.05). The postoperative hospital stay, treatment cost, VAS score at discharge, and the incidence of postoperative chronic pain and foreign body sensation were significantly lower in the study group than in the control group (P＜0.05). There was no significant difference in seroma, mesh infection, superficial incision infection, scrotal swelling, urinary retention, operative area skin cyanoplast and true recurrent between the two groups (P＞0.05). Conclusion The use of absorbable gauze instead of polypropylene mesh plug in Rutkow surgery can reduce the treatment cost and improve postoperative chronic pain and foreign body reaction