Hernia, commonly known as “small bowel gas”, is one of the most common diseases in human beings. Hernias occur mainly in the abdominal wall, including inguinal hernia, umbilical hernia, incisional hernia, lumbar hernia, etc. Among them, inguinal hernia, which occurs at the junction of lower abdomen and thigh, is the most common. Except for inguinal hernia and umbilical hernia in infants and young children, which can be temporarily observed clinically, most hernias require surgical treatment. Nowadays, with the convenience of the Internet, you can find a lot of articles and learn that there are various types of hernia surgery, so many patients and their families are also confused about what surgery is appropriate. From the perspective of clinical practice, each patient’s specific situation is different, so is there a common surgical selection principles and programs to follow to determine the best surgery for each patient? The answer, of course, is yes. Some guidelines formulated by medical authorities have set the basic direction, and we have summarized our work in the past ten years to formulate our surgical selection scheme and basic diagnostic and treatment principles by taking these authoritative guidelines as reference and combining them with our country’s and our hospital’s actual situation. These contents can be expressed in many tables and words, so we cannot expand them here, but if we have to summarize them in two words, they are “minimally invasive” and “individualized”. “Minimally invasive” means that the surgical methods we choose, the surgeries we perform and the related operations should be as minimally invasive as possible to the patients. The first is in the field of laparoscopy. In the last decade or so, laparoscopic surgery has become so widespread in the field of surgery that, in addition to the gallbladder, even tumors such as gastrointestinal and pancreatic tumors have begun to be operated on laparoscopically. In the field of hernia, laparoscopic hernia repair has also been carried out in some tertiary hospitals in major cities in China in the last decade. Laparoscopic hernia repair embodies many advantages that open surgery does not have, such as no incision in the inguinal area, less damage to the inguinal canal wall; more delicate operation through the magnifying effect of the laparoscopic lens, reduced trauma to the spermatic cord structure, the incidence of acute and chronic pain after surgery is low, mild; incisional hernia, bilateral hernia, recurrent hernia, hidden hernia has a unique advantage, and so on. Therefore, more and more doctors and patients are now choosing laparoscopic hernia repair surgery. The second dimension of minimally invasive is not limited to laparoscopy; it is about minimizing trauma to the patient whether laparoscopic or open surgery is used. Although damage to the wall of the inguinal canal is unavoidable with open surgery, trauma can be minimized by protection of the spermatic cord (including the concept of enhanced neuroprotection and spermatic cord vascular protection) and the use of preperitoneal repair. At the same time, in addition to local trauma, we have to consider overall trauma. Some elderly or poor cardiopulmonary function patients, if we only pursue local minimally invasive and do laparoscopic surgery, then laparoscopic surgery must be general anesthesia and pneumoperitoneum on the body as a whole to bring the adverse effects of laparoscopic surgery, often more than laparoscopic local minimally invasive benefit, at this time for such patients to do a semi or local anesthesia refinement of the open surgery is the real minimally invasive. Therefore, we still need to decide the specific surgical plan for different patients according to their different conditions, which is the second aspect of our surgical selection principles – individualization. The basic concept of “individualization” is easy to understand, that is, we have to decide the specific surgical method according to the condition of each patient and their own ideas. Taking the most common inguinal hernia as an example, the chart below shows the individualized surgical options for inguinal hernia in adults at our hospital. The chart gives us a basic idea of how to choose an appropriate surgical option for a patient with an inguinal hernia based on the patient’s specific condition. However, the chart is still not sufficient to show the full extent of “individualization”, especially when it is not read by professionals, but by the general public, and we are not able to expand on all the details. For example, laparoscopic surgery can be used in most patients, but if the patient has severe underlying cardiopulmonary disease, or a long history of a large hernia, or a history of major surgery for a tumor in the lower abdomen, open surgery should be chosen; laparoscopic surgery is preferred for bilateral hernias, recurrent hernias, or suspicion of contralateral cryptogenic hernia. Laparoscopic surgery, for example, is also divided into three specific types of surgery — TEP /TAPP /IPOM, which we have to choose according to the patient’s specific situation. In some cases, when there are two options, we respect the patient’s wishes. This is because different people think differently, and two patients in similar situations may choose different surgical options or patch materials. For example, men of childbearing age may choose between a biopatch or a synthetic patch with a large mesh; or some young women may forgo laparoscopy for the aesthetics of navel gowns because laparoscopy punches holes in the plane of the umbilicus, whereas open surgery wounds can be covered by underwear, and so on. In addition, the patient’s financial situation will also affect the surgical plan, laparoscopic surgery is more expensive, for the financial situation of the patient we can choose to local anesthesia open surgery in order to save as much money as possible. Please do not reprint this article without authorization.