Inguinal hernia, commonly known as “hernia”, is a common surgical condition in the elderly, with a much higher incidence than in young adults. Moreover, due to the characteristics of inguinal hernia in the elderly, the recurrence rate after treatment is also higher than that in young adults. Characteristics of inguinal hernia in the elderly: the body tissues of the elderly show a tendency of degeneration, the abdominal wall muscles and tendon membrane tissues become weak, some elderly people show excessive wasting or obesity and poor physical condition, when various reasons cause the increase of intra-abdominal pressure, it is difficult to resist the intra-abdominal pressure in the weak abdominal wall area, resulting in the protrusion of intra-abdominal organs through the abdominal wall or inguinal canal to form a hernia. In addition, elderly people have more underlying diseases, such as chronic bronchitis, prostate hypertrophy, diabetes, malnutrition, anemia, etc. There are many unfavorable factors that cause increased abdominal pressure such as cough, constipation and difficulty in urination, which directly increase the risk of morbidity, recurrence after treatment and other complications. Moreover, because of the many concerns of the elderly, they are generally reluctant to take the initiative to request surgical treatment. Often, the decision to operate is made only after the hernia has been present for several years and the condition has worsened and developed to the point where the symptoms are obvious, affecting the activities or appearing to be embedded, so it is often presented as a huge hernia sac or adhesion of the sac wall, which leads to difficulties in anatomical operation, increased trauma and poor postoperative recovery. The treatment of inguinal hernia in the elderly should be surgical in principle. However, preoperative examination should be performed for the presence of primary diseases that increase abdominal pressure (e.g. chronic bronchitis, prostatic hypertrophy, constipation, etc.), and if these conditions are present, relevant treatment should be given first to control the symptoms, because the presence of these factors can easily cause postoperative recurrence and result in failure of surgery. In addition, there are some elderly patients who rarely get out of bed and although the hernia sac is visible as huge, the physiological inlay of the surrounding tissues is very weak due to the enlargement of the inguinal canal internal ring opening and the possibility of inlay after herniation is small, and the patient has poor surgical tolerance and high risk, so there is little benefit from surgery, and non-surgical treatment may also be chosen as appropriate. The choice of surgical approach should be individualized, and the appropriate procedure should be chosen according to the different inguinal hernia staging. Tension-free hernia repair is considered the procedure of choice for the treatment of inguinal hernia in the elderly because of its simplicity, minimal postoperative pain and pulling discomfort, minimal trauma, rapid postoperative recovery, and low recurrence rate.