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This prospective randomized study aimed to evaluate the impact of hernia sac laparoscopy on the morbidity and mortality in cases with a spontaneous reduction of the strangulated hernia content before the assessment of its viability. Ninety-five patients underwent operation owing to incarcerated hernia. Forty-one patients, whose strangulated indirect inguinal hernia spontaneously reduced before the viability of the content was assessed, were included in this study. They were randomly assigned to 2 groups: group A (21 patients managed using hernia sac laparoscopy) and group B (20 patients managed without laparoscopy). The median hospital stay was 28 hours for group A and 34 hours for group B. Four patients of group B had major complications whereas there was none observed in the group A. Two unnecessary laparotomies and 2 deaths occurred in group B. Hernia sac laparoscopy seems to be an accurate and safe method allowing to prevent unnecessary laparotomy and especially in high-risk patients it contributes to decrease major morbidity.