Purpose To perform unilateral or bilateral inguinal hernia repair (IHR) is an ongoing dilemma for paediatric surgeons, due to the potential for metachronous contralateral hernia (6-30% in different studies, highest in premature neonates). One proposed solution is to perform hernioscopy to inspect the contralateral deep inguinal ring (DIR) during IHR. The aim of this study is to examine the detection rates and outcomes of hernioscopy for children presenting with a unilateral inguinal hernia. Methodology Retrospective audit from 2016-2025 of all children who underwent hernioscopy to assess the contralateral DIR during IHR. Results 113 children underwent hernioscopy over the 10 year period. The median age was 3 months (range 1 month to 12 years) and 79% were male. Contralateral IHR was performed in 46% of cases, with the most common indications being an open DIR and palpable gas in the inguinal canal. In 2/113 cases (2%) the contralateral DIR was unable to be visualised and repair was not performed. In one of these cases the patient re-presented post-operatively with a large contralateral hernia requiring repair. In one further case, a closed DIR was documented and the patient developed a contralateral hernia (1%). There were no complications attributed to hernioscopy during the study period. Conclusion In our population, hernioscopy was a safe and valuable approach to management of paediatric patients presenting with a unilateral inguinal hernia. Hernioscopy is associated with higher rate of contralateral repair compared to those performing unilateral repair, but a significantly lower risk of metachronous contralateral hernia (2%). The greatest value of hernioscopy is in patients at increased risk of contralateral inguinal hernia and/or associated hernia complications.