Inguinal hernia repair is one of the most commonly done general surgery elective procedures in the United States. Improvement in the repair has evolved its management to make it a very safe surgery. Management of incarcerated or strangulated Inguinal Hernia is very challenging as the numerous variabilities make the outcomes difficult to predict. Techniques vary from various open incisions to various forms of minimally invasive procedures to tackle the varied possibilities. In this video, we present an 80 year old gentleman who presented to the Emergency Room 9 years after an open inguinal repair with plug and patch, with an incarcerated and strangulated small bowel in the right groin. The hernia was unable to be reduced and he was emergently taken to the Operating room. He underwent a Laparoscopic transabdominal reduction of the small bowel. It appears extremely hemorrhagic and almost gangrenous. The hernia was repaired with an extensive dissection to reduce its content and place a preperitoneal mesh. The bowel appeared to improve and was not resected. Postoperatively he was admitted, he was discharged later once he was tolerating diet. He has been followed in the office and has no residual effects and is completely asymptomatic.

Conclusion: Laparoscopic repair of incarcerated near strangulated small bowel in inguinal hernia is a safe alternative, with advantages of safer recovery and less invasiveness.