PurposeTo compare the safety and outcomes of open and laparoscopic procedures in the management of congenital midureteral obstruction in children (CMO).MethodsBetween February 2008 and February 2022, a total of 18 patients underwent open ureteroureterostomy (OU group), and 26 underwent laparoscopic ureteroureterostomy (LU group). The operative time, postoperative hospital stay, hospital costs, postoperative complications, and success rates of the two groups were compared.ResultsThe median age of the patients was 59 months, with 29 patients presenting with asymptomatic hydronephrosis, 12 with intermittent abdominal pain, and 3 with flank mass. The median follow-up time was 42 months, and all patients were successfully treated surgically. The operative time and postoperative hospital stay in the LU group were shorter than those in the OU group (106.3 ± 21.4 vs. 85.8 ± 16.5 min, 11.6 ± 1.9 vs. 8.3 ± 1.7 days, respectively;p< 0.05). The OU group had two postoperative complications, both of which were classified as Clavien–Dindo grade II based on the Clavien–Dindo classification. One case of postoperative complication occurred in the LU group, which was classified as Clavien–Dindo Grade II. There was no significant statistical difference in complications between the two groups (P> 0.05).ConclusionsOur data showed that laparoscopic ureteroureterostomy is a safe and effective treatment for congenital midureteral obstruction in children, and provides several advantages, including fewer postoperative complications, shorter postoperative hospital stay, and a shorter operative time. Laparoscopic procedures should be the first choice for treating children with congenital midureteral obstructions.