Childhood inguinal hernia is as common in Chinese as in Caucasians. From 1980-85, 542 Chinese children with this condition were treated; important differences as well as similarities were found in the clinical features in the two patient populations. Incarceration was the major management problem (23.6%). It was found that enforcement of a management policy of enthusiastic reduction altered outcome significantly. Before the introduction of this policy (in the first five years), 39% of incarcerated cases resulted in emergency operation. In 1985, after its introduction, no emergency surgery was required. The move towards more vigorous attempts at reduction allowing surgery to be done electively was supported by two observations. First, the complication rate of emergency herniotomy (25.6%) was higher than that of elective herniotomy (6.5%). Second, in 43 emergency herniotomies, nonviable content (ovary) was found only once. In retrospect, most emergency herniotomies were unnecessary. In general, surgical treatment of the patients in this series could be considered satisfactory. However, better results were achieved by experienced surgeons, particularly those in specialty practice.