76 year old female patient admitted with strangulated left femoral hernia with signs of bowel obstruction, vomiting, distended abdomen. Had CT scan which confirmed the femoral hernia with strangulated bowel. CT scan pulmonary angiography confirmed PE. Patient started treatment for PE PMH: pulmonary embolism obstructed main right pulmonary artery. Dementia (usually confused/ agitated at home) and awaiting MRI head for dementia work up, Vit D deficiency Patient unwell and high risk for GA. Local considered but patient agitated and can’t stay in supine position for long Seen by anaesthetist and the decision made for spinal and laparoscopic extra-peritoneal hernia repair. Operation carried (TEP) out in 15 minutes, hernia repaired with mesh. hernia repaired and bowel reduced from extra-peritoneal space. Abdominal cavity inspected to check the viability of small bowel. Bowel viable Patient did very well and discharged home one week post op.