strangulated constitutes a surgical emergency. Symptoms include: Fever Nausea and vomiting Extreme pain in the area of the hernia Warm hernia bulge with surrounding skin redness Can no longer pass gas or stool Surgical repair within 6 hours of the above symptoms may be able to save the strangulated portion of the intestine. Although pediatric inguinal hernias sometimes present asymptomatically, surgical repair is still the standard of care to prevent hernia incarceration, which for children who are born with hernias has a risk of 12% in full-term children and 39% in preterm children. In preterm neonates, the timing for intervention appears to be of utter importance as surgical hernia repair after neonatal intensive care unit (NICU) discharge might decrease recurrence and anesthesia-induced respiratory difficulties compared to surgery before NICU discharge. Contraindications to surgery The person with the hernia should be given an opportunity to participate in the shared decision-making with their physicians as almost all procedures carry significant risks. The benefits of inguinal hernia repair can become overshadowed by risks such that elective repair is no longer in a person's best interest. Such cases include: People with unstable medical conditions Repair using mesh is withheld if a person has an active infection within the groin or within the blood stream Elective repair is delayed in pregnant women until 4 weeks after delivery Additionally, certain medical conditions can prevent people from being candidates for laparoscopic approaches to repair. Examples of such include: People who are unable to undergo general anesthesia Prior major open abdominal surgery People who have ascites Previous radiation therapy to the pelvis A complex hernia Surgical approaches Techniques to repair inguinal hernias fall into two broad categories termed "open" and "laparoscopic". Surgeons tailor their approach by taking into account factors such as their own experience with either techniques, the features of the hernia itself, and the person's anesthetic needs. The cost associated with either approach varies widely across regions, but updated guidelines published by the International Endohernia Society (IES) cast doubt on the comprehensiveness of cost comparison studies due in part to the complexity inherent in calculating costs across institutions. The IES asserts that hospital and societal costs are lower for laparoscopic repairs as compared to open approaches. They recommend the routine use of reusable instruments as well as improving the proficiency of surgeons to help further decrease costs as well as time spent in the OR. However,