Background: Hernia is the “protrusion of the viscous or part of the viscous through an abnormal opening in the walls of its containing cavity”. Inguinal hernias are the commonest of all hernias and adult inguinal herniorrhaphy accounts for 15% of operation in general surgery. Inguinal hernia is a common pathology seen during surgical practice. Objective: To find out risk factore and outcome of inguinal hernia repair under local anesthesia among elderly patients. Methods: In this prospective study was conducted in the Anesthesia Department, Sher-E-Bangla Medical College Hospital, Barishal, Bangladesh from January to December 2021. We enrolled 70 consecutive high risk elderly (age > 65 years) male patients who were admitted for repair of inguinal hernia outpatients’ department. Associated co-morbid conditions were labeled. All the patients received treatment with prosthetic mesh repair under local anesthesia. The patients were evaluated for tolerability and outcome of local anesthesia. Results: In the present study age of the patient varied from 20 to 70 years with the highest prevalence noted in the age group of 31-40 years. The mean age was 78.2±9.64 years (range 65–93 years). Present study shows more than 97.2% are male with only 2.8% of female presenting with inguinal hernia. Direct hernia was present in all (100%) patients, while 16(16%) patients also had indirect hernia. Right sided hernias were present in 67(67%) patients, while left sided hernias were present in 37(37%) patients. There were 71(71%) patients who had incomplete inguinal hernia, while 29(29%) patients had complete inguinal hernia. The frequency and percentage of the associated co-morbid condition. The procedure was successfully completed in all patients. The mean operative time was 46.35+7.82 minutes. No intra operative or postoperative mortality was observed. The mean hospital stay of the patients was 1.02+0.57 days. Pain during procedure was seen in 3(4.2%) patients, while nausea/vomiting and headache in 1(1.4%) patient each. Postoperatively, pain was seen among 3(4.2%) patients, urinary retention in 1(1.4%), inguinodynia in 1(1.4%) patient, and scrotal hematoma in 2(2.8%) patients. Conclusion: Our experience shows that prosthetic repair for inguinal hernia among elderly patients who are high risk for general or spinal anesthesia is well tolerated and has favorable outcome. In future it may erase the wait and watch strategy in such patients.