Pediatric inguinal hernia surgery is simpler than in adults, requiring only a “high hernia sac ligation”. What is a “hernia sac”? What does “high ligation” mean? Simply put, it means finding the hole where the hernia is coming out and tying the hole with a piece of string! The main reason why pediatric hernias do not require local repair and reinforcement like adult hernias is that they have different etiologies. Adult hernia occurs mostly related to the degeneration of the body, as if the clothes worn for a long time, tires used for a long time will wear out the hole, so you must use a piece of material (commonly known as “patch”), like patches on the hernia hole local coverage and strengthen, not to strengthen the body’s subsequent degradation of the continuation of the most likely to lead to a recurrence; and pediatric is congenital developmental anomalies, the closure of the channel (syringomyelia), and the development of the hernia. The child is a congenital developmental abnormality, should close the channel (sheath protrusion) is not closed, then we will artificially close it by means of surgical methods and means, do not need to do to strengthen the repair is because the strength of the abdominal wall of the child itself does not have a problem with the subsequent growth and development of the local tissues will be further strengthened, the probability of recurrence is very small. Of course, there are technical requirements to artificially close this sheath, must be ligated to the highest position, that is, against the root of the hole ligation, so the name of this operation is called “hernia sac high ligation”. If the ligature is not in place, and the hernia is only turned into a small protrusion, the hernia will easily recur. Currently, there are two types of surgeries: the traditional open surgery, which involves making a 2-3cm skin incision locally and separating it from the outside to the inside to find the hole for ligation; and the laparoscopic surgery, which involves drilling one or two 3-5mm holes in the abdominal wall, and then ligating the hole under direct vision using a laparoscope. The principle of both is exactly the same, but the pathways are completely different. Because small children are small and delicate, and inguinal hernias are in close proximity to the reproductive structures, the doctor has to be very careful, and the delicate spermatic cord can’t afford to be injured. Laparoscopic hernia sac ligation has all the advantages of minimally invasive surgery, both in terms of the operation itself and the characteristics of pediatric inguinal hernias: First, and most importantly, the spermatic cord of a child is immature and very small, so it is easy to be damaged by the separation process of an open surgery, whereas laparoscopy does not require the separation of the spermatic cord and the hernia sac, which avoids the damage to the spermatic cord and reduces hematomas and the impact on fertility. There are fewer hematomas and the impact on fertility is reduced. Secondly, the most root of the pediatric inguinal hernia etiology that does not close the hole is the peritoneum, the abdominal wall in this area is divided into seven layers from the skin to the innermost peritoneum, and ultimately our ligation is the peritoneal layer, so open surgery opens up the front layers that don’t actually need to be opened, and so the trauma to the inguinal canal is greater, whereas laparoscopic surgery does not need to move the front layers, which reduces trauma and reduces pain. Third, is that the laparoscopic view is in the abdominal cavity, which allows for better high ligation than open surgery, resulting in better outcomes and lower recurrence rates. Fourth, is the consistent advantage of laparoscopy, the pediatric perforations are smaller no sutures are needed and the incision is almost invisible. Fifth, is the manifestation of unilateral hernia children, in fact, about 20% of bilateral, but the other side is smaller not easy to detect, open surgery can not explore the opposite side, while laparoscopy can clearly see the opposite side, to avoid hidden hernia missed and the resulting secondary surgery. Therefore, after laparoscopic surgery for pediatric inguinal hernia, the child recovers quickly, without significant pain, can get out of bed after fully awakening from anesthesia, with few dietary restrictions, and can usually be discharged 1 day after surgery. Currently the only disadvantage of laparoscopic hernia sac high ligation is that is the cost of treatment is higher than open surgery.