Purpose: Congenital diaphragmatic hernia (CDH) is a developmental defect that causes herniation of abdominal organs into the thoracic cavity with significant morbidity. Thoracoscopic repair of CDH is an increasingly prevalent yet controversial surgical technique, with limited long-term outcome data within Asia. The aim of this study was to compare open laparotomy versus thoracoscopic repair of CDH in paediatric patients in a major tertiary referral centre. Methodology: We performed a retrospective analysis of neonatal patients who had open laparotomy or thoracoscopic repair for CDH in Queen Mary Hospital, Hong Kong between July 2002 and November 2021. Demographic data, perioperative parameters, recurrence rates and surgical complications were analysed. Results: 64 patients were identified, with 54 left sided CDH cases. 33 patients had a prenatal diagnosis and 35 patients received minimally invasive surgical repair. There was no significant difference between open and minimally invasive repair in recurrence rate (13% vs 17%, P = 0.713), time to recurrence (184 ± 449 days vs 81 ± 383 days, P = 0.502), or median length of ICU stay (11 ± 14 days vs 13 ± 15 days, P = 0.343), respectively. Gastrointestinal complications occurred in 7% of neonates in the open group and none in the thoracoscopic group. Median follow-up time was 9.5 years. Conclusion: Long term follow-up of this large congenital diaphragmatic hernia series demonstrated no significant difference in recurrence rate, time to recurrence or median length of ICU stay between open and minimally invasive repair, suggesting thoracoscopic approach is a non-inferior surgical option with avoidance of gastrointestinal complications compared to open repair.