Introduction: With the growing proportion of elderly people in the population, surgeonsare dealing with more frail patients. In addition, the prevalence of inguinal hernia increases withage. We aimed to compare the outcomes of watchful waiting and surgery in inguinal hernia patients who were 80 years of age and older had comorbidities and were minimally symptomatic. Materials and Method: Two high volume, mostly comorbid patient treating tertiary careeducation hospitals' databases were searched for inguinal hernia patients >=80 years of age. Onehundred and fifty four of the 324 patients treated between April 2010 and April 2014 were included in this study. Demographic characteristics, comorbidities and patient reported outcomeswere recorded from the database and telephone calls.Results: Mean patient age was 83±2.8 years and median follow-up time was 15 months. Atdiagnosis, 17 (11%) patients chose surgery, 137 patients were observed; of these, 74 (54.1%)crossed over to surgery, 48 (64.8%) elective and 26 (33.2%) emergency. The emergent operation rate for observation group was 18.9%. Crossover was found to be corelated with emergencyadmission before the diagnosis, increased pain in admission, low American Society of Anesthesiologists score, bowel resection and complications. Four patients were died within 30-days postoperatively, three in emergent and one in elective crossover. Mortality was corelated with heartfailure and bowel resection. Conclusion: Although recommending watchful waiting for 80 years of age and older inguinal hernia patients with comorbidities and minimal symptoms sounds logical, the natural courseof these patients is intriuging. Planned herniorrhaphy under local anaesthesia for extremely oldand comorbid patients seems more acceptable today.