Objective: To analyze the effects of laparoscopic high ligation of processus vaginalis on perioperative indexes, testicular blood supply and recurrence in children with hydrocele. Methods: A total of 150 children with hydrocele admitted to Anyang Maternal and Child Health Care Hospital were enrolled between January 2023 to September 2024. According to different surgical methods, they were divided into traditional group (n=71, traditional high ligation of processus vaginalis) and laparoscopic group (n=79, laparoscopic high ligation of processus vaginalis). The perioperative indexes, testicular blood supply [resistance index (RI) of testicular artery, end-diastolic velocity (EDV), peak systolic velocity (PSV)], inflammatory indexes [C-reactive protein (CRP), white blood cell count (WBC)], pain conditions [face,legs,arms,crying,consolability pain scale (FLACC)],complications and recurrence were compared between the two groups. Results: The perioperative indexes in laparoscopic group were better than those in traditional group (P<0.05). At 3 months after surgery, EDV and PSV in laparoscopic group were higher than those in traditional group, while RI was lower than that in traditional group (P<0.05). At 3d after surgery, CRP and WBC in laparoscopic group were lower than those in traditional group (P<0.05). At 12 h, 24 h and 48 h after the operation, the FLACC score of the laparoscopy group was lower than that of the traditional group (P>0.05). After 6 months of follow-up, incidence of complications in laparoscopic group was lower than that in traditional group (P<0.05). There was no difference in recurrence rate between the two groups (P>0.05). Conclusion: Compared with traditional high ligation of processus vaginalis, laparoscopic high ligation of processus vaginalis has better perioperative indexes in children with hydrocele, which can improve testicular blood supply, reduce inflammatory indexes and postoperative complications. The two surgical methods both have low recurrence rate.