Purpose <p>Incarcerated inguinal hernia is a common surgical emergency, and prompt identification of patients at risk for bowel resection and postoperative complications is essential. This study evaluated clinical and laboratory predictors for bowel resection in patients treated for incarcerated inguinal hernia.</p> Methods <p>In this cohort study, records of 184 patients who underwent surgery for incarcerated inguinal hernia between March 2018 and April 2023 were reviewed. Bowel resection, postoperative complications occurring within two years, and in-hospital mortality were considered in the study. The predictive factors were compared between groups with and without bowel resection.</p> Results <p>Bowel resection was required in 15 patients (8.2%). Significant predictors of bowel resection included preoperative bowel obstruction, opioid use, higher platelet count, and lower serum albumin (P-value &lt; 0.005). In-hospital complications occurred in 13 patients (7.1%). Of the 184 patients, 118 patients completed the two-year follow-up. Among these, 15 patients (12.6%) experienced at least one long-term complication. Overall mortality was 4.3%. Among inflammatory indices, Systemic Immune-Inflammation Index (SII) (AUC: 0.75), Neutrophil-Lymphocyte Ratio (NLR) (AUC: 0.70), and Platelet-Lymphocyte Ratio (PLR) (AUC: 0.71) demonstrated fair performance in predicting bowel resection.</p> Conclusion <p>Clinical assessment and timely intervention could mitigate the risk of bowel resection in patients presenting with incarcerated inguinal hernia. Knowledge of the aforementioned predictive factors may assist surgeons to prevent postoperative complications in patients with incarcerated inguinal hernia.</p>