Pediatric inguinal canal disorders are common and prevalent, including inguinal hernia, syringomyelia, and cryptorchidism, and are faced with management options of open syringomyelia (PPV) and contralateral occult open syringomyelia (cPPV). Traditional open transinguinal approach surgery with high ligation of the open sphincter or hernial sac is reliable, does not require transabdominal manipulation, and is not expensive, but has shortcomings. Open surgery requires opening the inguinal canal wall layer by layer, leaving scars after surgery and chronic inguinal pain may occur; a section of the spermatic cord and vas deferens needs to be freed along the hernia sac or sheath during surgery, which may be accidentally injured or misligated; scrotal hematoma or edema and medically induced cryptorchidism may occur after surgery; surgery on one inguinal area cannot explore the opposite side unless another incision is made on the opposite side; recurrence rate after surgery is about 0.8-4%. With the application of laparoscopy in the management of pediatric inguinal canal disease, its advantages are more obvious. Open sheaths on the affected side can be observed and treated laparoscopically; it is also observed that in nearly one-third to one-half of unilaterally affected children, open sheaths are also present on the contralateral side. cPPV can be called occult open sheaths, which are not detected by preoperative ultrasound and do not show any symptoms. During transumbilical laparoscopy, the question of whether to explore the contralateral side at the same time is no longer an issue. However, there is controversy as to whether cPPV is treated concurrently. cPPV presence does not necessarily present with symptomatic hernia or syringomyelia; however, PPV is a necessary condition for the development of hernia or syringomyelia. In clinical practice, it is common to see children with inguinal hernia, syringomyelia, or cryptorchidism on one side and then, after months to years, require a second surgical procedure for the reappearance of symptoms on the opposite side. If cPPV can be eliminated, a second surgery can be minimized. Laparoscopic exploration and simultaneous management of the contralateral side can be accomplished without additional incisions. The current difficulty is how to determine which cPPVs are likely to develop asynchronous hernia or syringomyelia and need to be treated concurrently when cPPV is found intraoperatively, and which ones do not need to be treated to avoid unnecessary trauma. However, at present, the criteria for judgment are not clear at home and abroad. After a series of improvements in laparoscopic techniques, our surgical approach to laparoscopic management of PPV is simpler, more effective, safer, and minimally invasive. When cPPV is detected laparoscopically, it is treated simultaneously without additional surgical complications and with maximum elimination of potential postoperative problems. The advantages of laparoscopic treatment also include: concealed incision, minimally invasive, cosmetic, preservation of inguinal canal wall integrity, avoidance of chronic inguinal pain, no need to free the spermatic cord and vas deferens during surgery, less scrotal hematoma or edema after surgery, etc.; and the possibility of “one-day surgery”. The disadvantage of laparoscopy is that it is expensive; the intraoperative puncture may accidentally injure the intestinal canal and blood vessels; the operation through the abdominal cavity may bring hidden problems such as intestinal adhesions, and it cannot eliminate postoperative recurrence. However, with the improvement of technical proficiency, experienced surgeons can avoid intraoperative accidental injury; the recurrence rate tends to decrease; intraoperative non-invasive intestinal tube, early postoperative bed activity, etc. can reduce or avoid the occurrence of intestinal adhesions.