Two hundred and seventy-one cases of inguinal hernias and hydrocoeles in children treated at the University Hospital of the West Indies over a five-year period have been reviewed. The dominance of the boys and the right side is borne out. The younger infant has the highest risk of incarceration which is more common in boys and in right-sided hernias. Females with inguinal hernia were screened for testicular feminization and none was found. There were three girls with hydrocoeles of the Canal of Nück. The incidence of metachronous presentation of contralateral hernia occurred only in 6.6% of cases. When routine exploration of the contralateral side was undertaken in 5.2% of cases, a hernial sac was found only in less than half of them. These findings support the present policy of not routinely exploring the opposite side in unilateral inguinal hernias. Herniotomy was adequate for 92.6% of cases. Herniorrhaphy was reserved for large hernias and sliding hernias. Complications were minor and infrequent. Recurrence was seen in only one case. One testicular atrophy occurred following incarceration. Eight-six per cent of these children were managed as day cases. In-patient management was required when the hernia was complicated or when there were associated other medical conditions.