Background: Laparoscopic hernia repair is reported to have superior outcomes in pediatric inguinal hernia repair, but its advantages in incarcerated inguinal hernia (IIH) are not defined. We compare the outcomes of laparoscopic (LH) versus open repair (OH) for pediatric IIH. Methods: We performed a systematic review on all published analyses of LH versus OH for IIH. We identified studies published in 2000-2018 from Medline, PubMed, Embase, Google Scholar and Cochrane databases. We included only studies on children aged ≤18 years, which compared both surgical techniques. Search terms were variations of ‘incarcerated inguinal hernia’, ‘hernia repair’, ‘laparoscopy’ and ‘child’. We categorised complications as major (testicular atrophy, ascending testis, recurrence, iatrogenic visceral injury) and minor (wound infection). Heterogeneity was assessed using I2; meta-analyses were performed using random or fixed effects models as appropriate. Weighted mean differences (WMD) or odds ratios (OR), with their corresponding 95% confidence intervals (CI), were used for analysis of continuous and dichotomous variables respectively. Significance level was p<0.05. Results: Our initial search yielded 549 unique citations. Eight retrospective cohort (RC) studies (584 patients) were included in the final analysis (339 LH, 245 OH). Overall, major complications (eight RC, n=584, OR=0.38,95% CI [0.17-0.88], p=0.02) were more common in OH. When each complication was assessed individually, there were no differences between groups. The length of hospital stay in the LH group was shorter than the OH group (five RC, n=418, WMD=-1.39, 95% CI [– 2.56- (-0.22)], p = 0.02). Conclusion: Laparoscopic repair for IIH is associated with less major complications and shorter hospital stay, but data is limited by the absence of randomised controlled trials.