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The objective is to compare needlescopic hernial repair versus open herniotomy (OH). Hernia is one of the most common operations performed in children which can be repaired by open technique or needlescopic technique. Case series analysis study was performed on 160 children; they were divided into two groups; 80 children were included in group A (needlescopic hernial repair), and 80 children were included in group B (open hernia repair). In group A, the average age was 2.8 years (SD 2.6); 60 cases were unilateral, and 20 cases were bilateral hernia (6 of these bilateral hernias were detected intraoperatively by patent processus vaginalis); scrotal hematoma appeared in 2 cases (2.5%), postoperative hydrocele appeared in 2 cases (2.5%), and postoperative recurrence for 12 months follow-up appeared in 2 cases. In group B, the average age was 2.6 years (SD 2.8), 62 cases were unilateral, 18 cases were bilateral, and postoperative hydrocele appears in 4 cases (5%) and no recurrence. No testicular atrophy or testicular ascent occurred in both groups. The one trocar needlescopic-assisted repair of pediatric inguinal hernia is safe and feasible in comparison to open herniotomy especially in bilateral, obese cases and can help in the diagnosis and repair of the contralateral side if patent. [ABSTRACT FROM AUTHOR]