Background: In skilled hands, laparoscopic repair of inguinal hernias has become an integral part of pediatric inguinal hernia management. Objective: The aim of the current study is to compare the outcome of laparoscopic inguinal herniotomy with excision of the hernial sac with laparoscopic inguinal herniotomy with just disconnection of the sac. Patients and methods: A randomized controlled clinical trial was conducted at Pediatric Surgery Department at Zagazig University Hospital, on 24 patients who had inguinal hernia. All cases were divided into two groups: Group A (n=13): Laparoscopic inguinal herniotomy by closure of the hernial defect by intracorporeal purse-string suture ligation of the peritoneum with excision of the hernial sac. Group B (n=11): Laparoscopic inguinal herniotomy by closure of the hernial defect by intracorporeal purse-string suture ligation of the peritoneum with just disconnection of the sac. Results: Testes size in Group (A) pre-operative was mean 238.58 (SD 133.507) mm2 and it was increased to be postoperative with a mean value of 256.33 (SD 127.278) mm2, while in Group (B) pre-operative mean 117.07 (SD 33.878) mm2 and it was increased to be postoperative with a mean value of 214.31 (SD 229.928) mm2. Preoperative data showed statistically significant variations between groups. Patients outcome in Group (A) show that 1 (7.7%) had scrotal hematoma, 1 (7.7%) had scrotal edema and 1 (7.7%) had wound infection, while in Group (B) 1 (9.1%) had scrotal edema, 1 (9.1%) had wound infection and 1 (9.1%) had recurrence. Conclusion: Laparoscopic closure of the internal inguinal ring in pediatric inguinal hernia with excision of the sac and closure after just disconnection of the sac have similar effect on pediatric laparoscopic inguinal herniotomy.