Purpose <p>Congenital inguinal hernia is a common condition treated by Pediatric Surgeons. Despite laparoscopy being the preferred method for many, there is still debate on its efficacy compared to the open technique. We compared our outcomes of laparoscopic percutaneous internal ring suturing with peritoneal thermal injury to open repairs.</p> Methods <p>Retrospective, cohort study from 2014 to 2023 at Dayton Children’s Hospital of children aged 17&#xa0;years or less who had an inguinal hernia repair by a Pediatric Surgeon via either of the two techniques. Demographics, operative technique, complications, hernia recurrence or metachronous contralateral hernia development, and follow-up length were collected.</p> Results <p>1,141 children were included, of which 61.5% (<i>n</i> = 702) had an open repair and 38.5% (<i>n</i> = 439) had a laparoscopic repair. Demographics were similar, except infants comprised a greater proportion of the laparoscopic group (45.1% vs. 36.2%, <i>p</i> = 0.002). There were more bilateral repairs in the laparoscopic group (<i>p</i> &lt; 0.001). Post-operative complications were similar. The recurrence rate was 2.5% with laparoscopic repairs and 1.1% with open repairs (<i>p</i> = 0.079).</p> Conclusions <p>The rate of hernia recurrence and other post-operative outcomes were similar for the two techniques, providing further evidence for the continued use of our laparoscopic technique.</p>