The patent processus vaginalis can appear as an indirect inguinal hernia, a hydrocele, a spermatic cord cyst or by the combination of two or three of these forms. Hernia is very common during childhood and its rate is increasing along with the ever growing survival of low weight premature child. Hernia must be operated without delay because of the incarceration risk. Cyst and hydrocele will only be operated after waiting for a spontaneous recovery. The clinical and diagnostic aspects of each one of the three modalities are revised. The irreducibility is analysed considering child characteristic aspects such as the risk for the testicle. On children, the surgical technique is based on high ligature of the patent processsus vaginalis. The management of special cases, such as the Testicular Feminizing Syndrome is described. The variants of technique used for the most difficult cases are also explained. The situations in which the simple ligature of the persistent duct is insuficient are remembered. The management of irreducible hernia is described. Being patent processus vaginalis often bilateral, the question of exploring or not the opposite inguinal area is considered. Standard procedure parameters for each case including the use of videolaparoscopic surgery are shown. Finally, the complications proper to hernia surgery on children are described remembering relapse is less usual than for adult surgery.
