it is a video presentation 55 years old Male patient. Admitted with bowel obstruction. Signs and symptoms of bowel obstruction, vomiting, abdominal distension. Abdominal examination: Irreducible lump in RIF on previous appendecectomy scar. PMH Liver cirrhosis due alcohol. Ascites PE Previous paracentisis Oesophageal varices. Diagnostic laparoscopic, bowel reduced . Bowel is viable Operation converted to TEP space created, hernia reduced and 15x15 cm prolene mesh placed. Patient discharged next day. Followed up by gastro.