Scrotal hernias can pose a challenge for surgeons. This video reviews a case with a recurrent inguinoscrotal hernia with colon involvement. The contralateral groin had a large direct hernia with incarceration of the bladder. The repair was performed with primary abandonment of the sac (PAS) for the recurrent hernia, and bladder reduction and standard repair on the the contralateral side. We review PAS strategies, preoperative case planning for hernias involving the colon, and peritoneal flap reconstruction techniques.