OBJECTIVE Inguinal hernia is one of the most common surgical conditions in infants and children. However, considerable debate exists regarding the role of laparoscopic hernia repair (herniorrhaphy) (LH) and its benefits over conventional open hernia repair (herniorrhaphy) (OH). The aim of this review is to analyze the current literature to determine the outcome of LH compared with OH. METHODS A literature search was performed on all studies published during the last 20 years, reporting on outcomes of OH and LH, in terms of operative time, recurrence rate and other complications, finding of rare hernias, and incidence of contralateral patency. The chi-squared or Fisher's exact test was used to analyze the results of the study. RESULTS Fifty-three studies matched our inclusion criteria. As for operative time, in unilateral inguinal hernia repair, there was no significant difference between LH and OH (P=.33). In contrast, in bilateral disease, LH is faster than OH (P=.01). As for the recurrence rate, no significant difference was observed between the two techniques (P=.66), whereas the rate of other complications was significantly higher for OH compared with LH (P=.001). Laparoscopy has the advantage to identify and treat rare hernias (direct, femoral, "en pantalon") that are never reported in articles focused on inguinal OH. In laparoscopic series, in the case of unilateral hernia, the incidence of contralateral patency varied between 19.9% and 66%. CONCLUSIONS In this systematic review, it seems that LH is faster than OH for bilateral hernias, whereas there is no significant difference in terms of operative time for unilateral inguinal hernia repair. Recurrence rate is similar for both techniques. As for other complications such as wound infections, it is higher for OH compared with LH, especially in infants. A prospective comparative study is necessary on this topic to strongly support the results of our systematic review.