The incidence of hiatal hernia in children is around 5-6%, so it is extremely common and requires surgery. However, with the current minimally invasive surgery getting better, parents have a new choice, and many are torn between choosing minimally invasive and traditional surgery, which one should they choose? When to operate? I would like to briefly explain them in the hope of clearing parents’ doubts. First of all, let’s talk about the advantages and disadvantages of both. Traditional surgery does not require access to the abdominal cavity, is less expensive, and excellent surgeons can achieve a wound of about 1 cm or less, but postoperative local edema and hematoma are heavy and cannot detect whether there is a hiatal hernia on the opposite side. The advantages of minimally invasive laparoscopic surgery are that it can simultaneously detect the presence of a hiatal hernia on the contralateral side, treat bilateral hiatal hernias together, have light local edema and hematoma, and can simultaneously explore and treat intra-abdominal lesions incidentally, making full use of the umbilicus, with inconspicuous wounds, but at high cost and with some risk when establishing a pneumoperitoneum. There is no significant difference in the recurrence rate after the two procedures. How to choose? The decision can be based on the morbidity of the hiatal hernia. According to statistics, the chance of a right-sided hernia combined with a left-sided hernia is low, and the chance of a left-sided hernia combined with a right-sided hernia is high, so minimally invasive laparoscopy is preferred for left-sided hernia. When to operate? According to foreign opinion (pediatric surgery 6th edition), surgery within one month of the diagnosis of hiatal hernia can avoid more than 90% of the complications caused by hiatal hernia, that is to say, surgery can be performed at 2-3 months of life, while the domestic opinion is that surgery is needed at one year of life if the hernia does not heal spontaneously, or earlier if there is a history of intussusception.