Background <p>Laparoscopic repair of congenital inguinal hernia (CIH) has evolved with techniques to minimize invasiveness while ensuring efficacy. This study compares percutaneous internal ring suturing (PIRS) with laparoscopic disconnection of the hernial sac and internal ring narrowing regarding feasibility, safety, operative time, cosmetic outcome, and recurrence rate.</p> Methods <p>A prospective randomized study was conducted on 109 male patients with 120 CIHs. Patients were allocated into two groups: Group A (laparoscopic disconnection and internal ring narrowing) and Group B (PIRS). Perioperative parameters, postoperative complications, recurrence rates, and parental satisfaction with cosmetic results were assessed.</p> Results <p>The mean operative time was significantly shorter in group B (8.5 ± 3.9&#xa0;min for unilateral cases) compared to group A (40.8 ± 9.9&#xa0;min) (<i>p</i> &lt; 0.001). Postoperative spermatic cord edema occurred in 19.6% of Group A and 1.9% of Group B (<i>p</i> &lt; 0.05). Recurrence rates were 5.4% in Group A and 1.9% in Group B (<i>p</i> &gt; 0.05). Parental satisfaction with scarring was significantly higher in group B (<i>p</i> &lt; 0.05).</p> Conclusion <p>In this randomized trial, PIRS resulted in shorter operative time, lower incidence of spermatic cord edema, and higher parental satisfaction compared with conventional laparoscopic repair in pediatric patients with congenital inguinal hernia.</p> Level of Evidence <p>II (Prospective randomized study).</p>