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Reported recurrence rates after laparoscopic versus open inguinal hernia repair have been limited to high volume centers with short follow-up. We sought to compare national rates of recurrence after laparoscopic versus open bilateral inguinal hernia repair.Children under five who underwent bilateral inguinal hernia repair between 2010 and 2020 were identified using the PearlDiver Mariner database. Time to recurrence was compared using Kaplan Meier analysis and Cox proportional hazards regression models.Hernia recurrence requiring reoperation occurred in 182 (2.2%) of 8,367 children. Rate of recurrence was higher following laparoscopic repair compared to open (1-year: 2.8% vs. 1.5%; 3-year: 3.7% vs. 2.0%; p 0.01). This difference remained after adjustment for demographic and operative characteristics (adjusted hazard ratio [aHR]: 2.00 [95% confidence interval [CI]: 1.31, 3.05]).Risk of recurrence was higher after laparoscopic compared to open repair of bilateral inguinal hernia repair in a national cohort of children under age five.