Inguinal hernia is a hernia formed by the protrusion of intra-abdominal organs through a defect in the inguinal region to the body surface, commonly known as “hernia”. The inguinal region is a triangle located at the junction of the lower abdominal wall and the thigh. According to the relationship between the hernia ring and the inferior abdominal wall artery, inguinal hernias are divided into two types: inguinal hernia and inguinal hernia. Inguinal hernias occur in the majority of males. The ratio of male to female incidence is 15:1, with the right side being more common than the left. The incidence of straight hernias has increased in elderly patients, but hiatal hernias are still the most common. With the advent of an aging society, hernias are plaguing more and more elderly people and are prone to serious complications if not treated promptly. There are many causes of inguinal hernia, mainly reduced abdominal strength, and increased intra-abdominal pressure. Muscle atrophy and weakness of the abdominal wall in the elderly, and even more weakness in the inguinal region, combined with the passage of blood vessels, spermatic cords or round ligaments of the uterus, give access to the formation of hernias. In addition, elderly people tend to have coughing and asthma, constipation, and difficulty in urination due to prostate enlargement, resulting in elevated abdominal pressure, which provides the impetus for hernia formation. The possibility of inguinal hernia should be considered if there is a reversible mass in the inguinal region, i.e., it appears when standing, walking, coughing or laboring and disappears when resting flat. The vast majority of inguinal hernias can be diagnosed based on the clinical symptoms of the patient and the physician’s examination. If the hernia is relatively small and the presentation is atypical, the diagnosis can be basically confirmed by ultrasound examination. There is a misconception about the treatment of inguinal hernia that it is not life-threatening and therefore can be treated or not. However, once the inguinal hernia fails to retract and forms an incarcerated hernia, it can lead to intestinal obstruction, even intestinal necrosis and perforation, and even death, with a morbidity and mortality rate of about 15%. Treatment of inguinal hernia includes conservative and surgical treatment. Conservative treatment includes hernia belt, hernia brace, Chinese medicine and herbal medicine, etc. These methods can relieve the symptoms or delay the development of the disease, but they cannot cure it, and even some improper conservative treatments can aggravate the disease. Nowadays, some unscrupulous “doctors” take advantage of patients’ fear of surgery and advocate hernia without surgery to cheat them out of their money, so we must take precautions. Adult inguinal hernia is not self-healing and surgery is the only reliable method to treat adult inguinal hernia, which is less likely to recur. Easily recurring hernias should be selected for surgery at the appropriate time, while surgery should be limited to a short period of time for refractory hernias, and emergency surgical treatment must be undertaken for incarcerated and strangulated hernias to avoid more serious consequences. Surgical treatment is further divided into traditional tissue-to-tissue tension suture repair and tension-free hernia repair techniques, which are currently internationally recognized as tension-free hernia repair techniques, including open and laparoscopic procedures. I. Traditional surgery Traditional surgery requires patients to fast before and after surgery, to be bedridden for several days after surgery, to receive fluids, and to be placed under a urinary catheter. Patients have severe postoperative pain, slow recovery, and high recurrence rate, and many patients with heart, lung, and cerebrovascular comorbidities are unable to operate because they cannot tolerate general anesthesia or hemi-anesthesia. With the emergence of new materials and technologies, the most widely performed hernia surgery is tension-free hernia repair surgery using artificial materials, which includes open and laparoscopic procedures. Open tension-free hernia repair In 1997, open tension-free hernia repair was introduced from abroad to China and became rapidly popular. The recurrence rate is low, the pain is low, the surgery can be done under local anesthesia, and generally only 2-5 days of hospitalization are needed, or even the surgery can be done on an outpatient basis without hospitalization, and the postoperative recovery is fast. The open tension-free hernia repair methods commonly used in China are summarized as follows: 1. Flat patch tension-free repair method (Lichtenstein surgery): Lichtenstein surgery involves suturing the patch to the wall of the inguinal canal and the spermatic cord is led out through the perforation of the patch. Until 1997, it was recognized worldwide as the most classic procedure for hernia surgery. Many hospitals still have many surgeons performing this procedure. 2. Tension-free hernia ring filling (Gilbert, mesh plug & patch): This procedure combines mesh plug filling (mesh plug, 1994) and Lichtenstein’s procedure, that is, the hernia ring defect is filled with polypropylene rolled into an umbrella shape, then the posterior wall of the inguinal canal is strengthened with a flat patch, and at one time the umbrella filling and the flat patch were not fixed, then Rutkow and Robbines suggested that the umbrella filling and the flat patch should be fixed. Robbines suggested fixing the umbrella filling and flat sheet separately, which is a popular hernia repair procedure abroad and the most rapidly developing procedure in recent years. This is a new tension-free hernia repair method proposed in 2000, in which the transversus abdominis membrane is opened during open surgery, the anterior peritoneal space is freed, and the patch is placed in the anterior peritoneal space to repair the pubococcygeal muscle foramen area. With the rapid development of synthetic material science the patch material has reached the ideal requirement, thus realizing the overall repair of the three potential defects of the internal ring, direct hernia triangle and femoral ring, which is the concept of total inguinal repair. 4. The three-in-one —- tension-free hernia repair method (prolene hernia system , PHS) This procedure applies a specially designed hernia repair patch, which consists of three parts: an underlying piece placed in front of the peritoneum to repair the pubococcygeal muscle foramen; a plug-like intermediate to repair the hernia ring; and a superficial piece to repair the posterior wall of the inguinal canal. This is a method introduced in recent years, and there are many hospitals in China performing this kind of surgery. Laparascopic repair of inginal hernia: In 1982, Dr. Ger in the United States performed laparoscopic inguinal hernia repair for the first time and succeeded, and the clinical reports of this technique gradually increased and diversified repair methods appeared, which brought a new technology to inguinal hernia repair and showed a broad prospect. In recent years, with the improvement of medical devices and surgical techniques, laparoscopic surgery has made significant progress. Due to the smaller wound, the postoperative pain is light, the discomfort reaction is small, the recovery is fast, there is less chance of wound infection, and the patient can go home for daily life on the second day after surgery, and can return to work 1-2 weeks after surgery. In addition, laparoscopic total extraperitoneal repair is most suitable for bilateral inguinal hernias and recurrent hernias. This procedure has been accepted by more and more patients due to its advantages of less trauma, faster recovery and lower recurrence, and the gradually decreasing gap between the treatment cost and that of open artificial mesh repair. Both open and lumpectomy are currently internationally accepted treatments. The open procedure is simple and quick, and local anesthesia expands the indications for surgery, making it a more affordable option. The lumpectomy is less invasive without a large incision and has less postoperative pain and shorter return to work, but requires general anesthesia and is more costly. Whether a patient with inguinal hernia is suitable for laparoscopic or open surgery, the doctor should fully inform the patient of the respective risks and advantages of open and lumpectomy surgery, combined with the doctor’s professional advice to make the choice.