increased. Ability to detect and repair contralateral inguinal hernia (CIR) simultaneously, along with safe, high ligation of the hernia sac without injury of the vas or the spermatic vessels, make the laparoscopic approach a reliable alternative to the conventional open techniques. Aim:The aim is to detect risk factors of contralateral patent processus vaginalis (CPPV) to facilitate the selection of appropriate patients for contralateral exploration. Method:In this prospective cohort study, all children ≥12 months presented with unilateral hydrocele or inguinal hernia were included in the study and underwent concurrent ipsilateral inguinoscopy to visualize CIR during the initial surgery. Children with clinically bilateral diseases or who had previous inguinal or pelvic surgery were excluded from the study . An open inguinal herniotomy was done, and an inguinoscopy was performed by opening the sac, and a 5 mm reusable port was introduced. After CO2 insufflation with the patient in the Trendelenburg position, a 70˚ angled 4 mm telescope was then introduced, and CIR was observed as an inverted U-shaped ring at the junction of the vas deferens with the spermatic vessels. The primary objective is the result of inguinoscopy to be compared with preoperative examination and ultrasonography to detect possible risk factors. Results : •In total, 24 boys were enrolled in the study. Their mean age was 34.5 ±19.2 months. •There was a history of contralateral hernia/hydrocele in 5 boys and a history of ventricular shunt and ascites in 3 boys. •By examination at an outpatient clinic, under anesthesia and the Inguinoscrotal US, there were 4, 10, and 5 cases respectively. suspicious to had CPPV, while inguinoscopy was positive in 6 cases. •There was no, slight and moderate agreement between examination at the outpatient clinic, examination under anesthesia, and Inguino-scrotal US as indicated by kappa values (-0.25, 0.091 and 0.412) with inguinoscopy results, respectively. •Based on inguinoscopy result as a reference, the sensitivity, specificity, PPV, NPV, and accuracy of Inguino-scrotal US were the highest (50%, 88.9%, 60%, 84%, 79.1%), respectively Conclusion:Ipsilateral inguinoscopy has an additive effect and does not increase the operative time or complications. Risk factors are oscillating the closure of CPPV.