Generally, no surgeon is willing to perform laparoscopic surgery on a patient who has previously had abdominal surgery. This is because the previous surgery will result in severe intra-abdominal gauge adhesions and laparoscopic surgery will be more difficult and risky. Most physicians include patients with previous abdominal surgery as contraindications to laparoscopic surgery. In fact, many things are not absolute. I received a patient with an inguinal hernia in his 70s in May 2016. He had previous major abdominal surgery, and the surgical incision ran from the subxiphoid process of the chest to the pubic symphysis. Many of my colleagues advised me to simply do open hernia surgery, which would be safe and save the trouble. However, this would create an additional surgical incision in the lower right abdomen, and the patient would not dare to get out of bed for several days after the surgery because of continuous pain. Luckily, the family was reasonable and expressed their willingness to try laparoscopic hernia repair first, and in case of serious adhesions, they were willing to switch to traditional open surgery at any time. After thorough preparation, we marked the location of the incision for open surgery in the right groin, bypassed the original incision site, established a laparoscopic pneumoperitoneum under direct vision, placed a laparoscopic camera, and started a careful abdominal exploration. The intra-abdominal adhesions were indeed severe, but far from impossible to separate. You can see the dynamic images below. After efforts to separate the adhesions, the laparoscopic hernia repair surgery was finally completed successfully. After surgery, except for scrotal swelling and short-term pain, the patient had no other discomfort and no huge surgical incision on the abdominal wall, and was discharged from the hospital the next day. The picture below is a photo sent by the patient after discharge. As you can see, the patient has a tiny surgical scar of about 5 mm on each side of the abdomen. Inguinal hernia surgery is a common and multifaceted condition. The current trend is toward minimally invasive surgery and ambulatory surgery. Minimally invasive laparoscopic surgery simply means that the surgical incision is minimally invasive; in fact, the intra-abdominal manipulation is no less extensive than that of open surgery. For unilateral inguinal hernia, Beijing medical insurance only reimburses about 3,000 yuan, and the rest of about 10,000 yuan has to be borne by oneself. For those patients who are financially well off and have higher requirements for surgical pain and aesthetics of the surgical incision, laparoscopic hernia repair surgery is an option. The disadvantage is that it requires higher laparoscopic skills and costs more for the surgeon. In addition, elderly patients, patients with severe combined prescribed cardiac, cerebral and pulmonary diseases, who cannot tolerate general anesthesia, cannot do laparoscopic hernia repair. There is another very convenient and friendly surgical procedure, the traditional hernia repair surgery under local anesthesia, which is also the main surgical procedure promoted for day surgery. Because of the local anesthesia, the surgery is short and quick, with minimal impact on the patient’s heart and respiratory nervous system. You can leave the hospital and go home after one or two hours of rest. Therefore, hernia repair surgery under local anesthesia is very suitable for those patients who are elderly and have severe combined prescribed cardiac, cerebral and pulmonary diseases. Two days ago, I successfully performed inguinal hernia repair under local anesthesia on an 89-year-old patient with cerebral thrombosis in the gastroenterology department. Almost no one dares to take over the surgery for hernia in such an old and high-risk patient. This surgery is simple and inexpensive, but because it requires the use of a hernia patch, the costs incurred will also exceed the reimbursement of Beijing’s medical insurance (the cost of the patch still needs to be paid out of pocket).