Inguinal hernia is one of the most common conditions in pediatric surgery. Pediatric hiatal hernias are more frequent in boys and are more common on the right side. Most develop within 2 years of age and present as a painless mass that is retractable from the groin to the scrotum. Surgical treatment is required. Etiology The etiology of inguinal hernia in children can be congenital, i.e., unclosed peritoneal sheath, or acquired: crying, constipation, chronic cough, ascites, etc. Sometimes the unclosed sphincter is in the form of a narrow canal or partially closed, and various types of syringomyelia are formed. Department of Surgery, Kunming Children’s Hospital, Kunming, China Pathology The inguinal hernia contents in children are mostly small intestine, and the greater omentum may enter the hernia sac in larger children. The right hernia contents can be the cecum and appendix. In girls, the hernia sac may contain ovaries and fallopian tubes. It can be divided into testicular hernia and spermatic hernia. Clinical presentation Pediatric hiatal hernia initially presents as a retractable mass. Sometimes it appears at the first cry after birth, sometimes in the first few months of life, and most of them occur within 2 years of age. It is usually asymptomatic and may feel swollen and does not interfere with activity. The swelling appears or increases when standing, crying or exerting force, and becomes smaller or disappears after lying down or sleeping. The mass can be incorporated into the abdominal cavity by gently squeezing upward with the hand, and a “gurgling” sound can sometimes be heard during the rejection. Pediatric hiatal hernia is prone to entrapment (the mass cannot be retracted by itself) and mostly occurs in infants and children under 2 years of age. The hernia suddenly enlarges and hardens and cannot be retracted, and the child cries a lot. Surgical treatment of hiatal hernia rarely heals spontaneously, and the hernia mass increases in size with age, and intussusception and ischemia may occur. Currently, the minimum age for surgery is 6-12 months if there is no recurrent intussusception. Pre-operative treatment of pre-existing factors of increased abdominal pressure, such as chronic cough, urinary difficulties, constipation, etc., should be performed. The surgical procedure for pediatric hiatal hernia is a high ligation of the hernia sac. It is a less invasive procedure with fewer steps and less impact on the child. The surgery is performed under intravenous or inhalation anesthesia, and post-operative awakening is quick and the child is not left with a horrible memory. As long as the spermatic vessels and vas deferens are protected during the surgery, it will not affect the child’s future fertility; on the contrary, if the surgery is delayed, the contents of the hernia often appear to be stuck on the spermatic cord, which may affect the development of the testes and thus the sexual and reproductive functions.