An elderly patient with inguinal hernia, 75 years old, was recently admitted to the emergency room with a “recurrent protruding mass in the right groin for 8 years, unable to retract for 6 hours”. He had a previous diagnosis of “Perkins’ disease” for 7 years and had been bedridden for most of the last 2 years, with half an hour of bed activity daily; 2 years after prostatectomy; and 10 years of chronic bronchitis. The patient had been seen in our hospital 2 years ago and was recommended for surgical management, but the family insisted on refusing surgery. Because of the obvious local pain of the swelling, inability to retract, and lack of anal venting and defecation, the patient was highly suspected of having an incarcerated hernia and decided to undergo emergency surgery. According to the patient’s general condition, lumbar anesthesia could not be performed, and the risk of general anesthesia was high. Considering the absence of acute toxic symptoms such as fever, rapid heart rate and obvious abdominal pressure and rebound pain, inguinal hernia repair under local anesthesia was performed after full conversation with the family and consent was obtained. It was confirmed intraoperatively that the small intestine was embedded, the mesentery showed ischemia, and the blood flow of the intestinal canal was acceptable, so the hernia sac was retracted by decompression and the mesh was placed for repair, and postoperative fasting, anti-inflammatory and symptomatic treatment were given, and recovery was possible. Although this patient was finally treated with minimal trauma, we still feel afraid and regretful. If the patient had cunning necrosis of the small intestine, the surgical trauma and anesthesia risk would have been high, which would have undoubtedly been a big blow to this patient and could have been life-threatening; if the patient had undergone surgical management (tension-free mesh repair of inguinal hernia under local anesthesia) in our hospital 2 years ago, she would not have faced such a big risk today. So when exactly should an elderly inguinal hernia be operated is probably a question for many patients! The reason why this patient did not have surgery two years ago was because his daughter in the United States insisted that her father was not fit for surgery at an advanced age. In fact, I would like to emphasize here that for the vast majority of elderly patients, hernia repair surgery under local anesthesia is minimally invasive, with minimal risks from anesthesia to surgery, half an hour to an hour to complete the surgery, no intravenous fluids, and discharge the next day, with very little possibility of recurrence as long as activities with high abdominal pressure are limited and chronic symptoms such as chronic cough and chronic constipation are controlled. Inguinal hernia is not self-healing and the only effective treatment is surgery. Therefore, in all elderly patients, as long as the quality of life is affected, early surgical treatment is recommended, and the better the situation is, the better the results of surgical treatment will be. Do not wait until the intussusception causes serious complications such as intestinal necrosis or until you are very old to think about surgical treatment, because at that time all that is left is regret.