The inguinoscrotal region is one of the most common areas operated on in pediatric surgery. Despite this, the surface anatomy of the pediatric inguinal canal is variably defined. The aim of the current systematic review is to evaluate the development and surface anatomy of the pediatric inguinal canal. A systematic review of inguinal canal anatomy in children was conducted using the electronic databases: Medline, PubMed, Scopus, and Google Scholar. Relevant anatomical measurements and relationships were reviewed. The anatomical structures forming the walls of the inguinal canal were identified in fetuses as early as 8-10 weeks gestation. No studies addressed the developmental basis of this early defect in the lower anterior abdominal. Later gonadal development and descent has a defined role. In vivo measurements of children carried out during open surgery are inconsistent. Some studies showed rapid growth velocity of the length of the inguinal canal up to 2 years of age (with height and growth of the bony pelvis) before plateauing, while others suggested no increase in canal length prior to 10 years of age. The position of the deep inguinal ring was equally unclear; some studies suggested this was medial to the midpoint of the inguinal ligament. No studies described the position of the superficial ring, challenging the assumption that the rings are superimposed in the neonate. The dearth of studies analyzing pediatric inguinal anatomy means that changes in the position of the rings with respect to the lengthening of the canal remain unclear.