Introduction Palliative surgery for a large inguinoscrotal hernia in advanced cancer patients presents unique challenges, balancing symptom relief against risks of complications and mesh use in potentially tumour contaminated fields. We report a case of palliative hernia repair in a stage IV colorectal cancer patient with a large inguinoscrotal hernia and discuss implications for mesh use. This case highlights the need for individualised care in managing symptoms and improving quality of life in advanced cancer. Methods A 32-year-old male with metastatic colorectal cancer (stage IV), a large Sister Mary Joseph lesion, and a symptomatic inguinoscrotal hernia underwent palliative repair. The indirect hernia sac was divided, contents reduced, and a mesh placed after closing the proximal sac to manage malignant ascites. A literature review was conducted on palliative hernia repair and mesh use in advanced cancer, focusing on outcomes and complications. Results The patient recovered well post-operatively, with the hernia site healing and groin pain resolution at 4 months. Despite refusing cancer treatment, the patient was grateful for symptom relief. This literature review suggests palliative hernia repair can improve quality of life with low complication rates [1]. Studies support mesh repair as feasible in advanced cancer, with low morbidity and improved symptoms [2]. However, mesh use in stage IV cancer is debated due to risks of infection and cancer seeding. Conclusion Palliative hernia repair can effectively manage symptoms in advanced cancer patients, improving quality of life. Mesh use should be individualised, considering risks and benefits. This case underscores the importance of symptom management in palliative care. Further research is needed to guide management in stage IV cancer patients. References: 1. Jensen KK, et al. (2017). Palliative surgery for inguinal hernia in patients with advanced cancer. _Br J Surg_, 104(1), 61-67. 2. Sogaard K, et al. (2020). Palliative hernia surgery in patients with advanced cancer. _BMC Palliat Care_, 19(1), 1-8.