Purpose Neonatal inguinal hernias (IH) are common, with an incidence of 3-5% in term neonates and up to 30% in neonates with a birth weight of <1kg. The risk of incarceration is greater in neonates and typically repair is performed prior to discharge. Historically, regional anaesthesia (spinal/caudal) was performed due to proposed lower rates of apnoeas/airway complications. However, this can result in more technically challenging operations under time pressure. Contralateral repair is controversial. Townsville University Hospital (TUH) serves a neonatal catchment area of >750,000km2. This distance has a significant impact on emergency transfer times and time spent by families away from home while awaiting repair. The purpose of this study is to retrospectively audit neonates undergoing IH repair in our regional centre. Methodology Retrospective review of 154 neonates (post conceptional age <60 weeks) undergoing IH repair at TUH from 2019-2023. Results Aboriginal and Torres Strait Islander neonates were greatly overrepresented (30% versus 9% of the population). Nearly 2/3 lived >150km from TUH (66%). 40% underwent an operation under regional anaesthesia and 60% under general anaesthetic (GA). The rate of airway apnoeas did not differ between the two groups. Bilateral inguinal herniotomy was performed in 96% and the surgical complication rate was low. Conclusion This study and other recently published papers suggest that apnoeas post regional anaesthesia are similar to that post GA. In our population, bilateral inguinal herniotomy has become routine with a low incidence of complications. It was also unexpected to find a significant over-representation of Indigenous neonates, possibly relating to higher rates of prematurity.