Inguinal hernia in children

The second most commonly performed surgery in children around the world is for the inguinal hernia. The parents notice a bulge in the groin and contact the surgeon. The following questions and answers will help parents understand the topic well. Please note that this publication is about the inguinal hernia in children and that the treatment in adults differs from that in children.

What is an inguinal hernia?

As a male fetus grows and matures during pregnancy, the testicles develop in the abdomen and then move down into the scrotum through an area called the inguinal canal. Shortly after the baby is born, the inguinal canal closes, preventing the testicles from moving back into the abdomen. If this duct does not close, it forms a connection between the abdomen and the scrotum, allowing the abdominal contents to pass through the duct into the scrotum.

Although girls do not have testicles, they do have an inguinal canal, so they can get hernias in this area as well.

Hhow common is inguinal hernia?

The incidence of inguinal hernia is in the range of about 1-3% of all children. It is more common in premature babies and boys than girls. The inguinal hernia can occur on either side, although it is more common on the right than on the left. At a younger age, the frequency of bilateral hernias is more common.

What are the symptoms of a hernia?

Hernias can occur at any age, from newborns to the elderly. Inguinal hernias appear as a bulge or swelling in the groin or scrotum. The swelling may be more noticeable when the baby cries and may get smaller or disappear completely when the baby relaxes. Straining and crying do not cause hernias; however, the increased pressure in the abdomen can make a hernia more noticeable. If your doctor gently presses on this bulge when the child is calm and lying down, it usually shrinks or moves back into the abdomen.

Why is a hernia a concern?

Occasionally, the loop of intestine that protrudes gets stuck in the sac and cannot be pushed back into the abdomen. When this happens, that part of the intestine that’s in the hernial sac can lose its blood supply. It is a life-threatening emergency and requires emergency management. The risk of surgery in an emergency is always greater than the planned surgery and so the hernia is a concern.

What happens if the complication due to a hernia occurs?

This child develops the acute onset of swelling in the groin with pain. After a few hours, the child may develop abdominal distension and vomiting. It is an emergency and parents should consult the surgeon as soon as possible.

Is there a need for research?

Normally, hernias are diagnosed by a physical examination by the doctor. Ultrasound is occasionally performed to differentiate hernia with bowel versus fluid or omentum. The child will need a complete blood count, viral markers, and bleeding profile before surgery.

What is the treatment?

These hernias do not go away without surgery and must be repaired to avoid complications such as irreducibility, obstruction and strangulation: because if these complications occur, the affected bowel may become damaged and may require removal with increased risk and morbidity.

Is anesthesia necessary? If so, what type of anesthesia?

Yes, all operations on children are performed under general anesthesia.

How long should the child be fasting before the operation under general anesthesia?

How long does the child have to fast before the inguinal hernia is repaired?

Type of feed Duration
breast milk four o’clock
Formula feeds six o’clock
solid food eight o’clock

What exactly happens in the operation?

The surgeon closes the opening through which the hernia protruded from the abdomen into the groin.

How long should the child be fasting after surgery?

Usually the child starts eating after 2-4 hours. First sips of water followed by liquids and then solids. If the child is nauseous or vomiting, feeding should be stopped for 2 hours.

What kind of food is allowed after surgery?

The child receives regular food, preferably non-spicy, non-acidic and non-greasy.

Do you have pain after surgery?

There is some pain, which is easily controlled with medication.

How long does the child have to stay in the hospital?

The operation can be performed as a day case, which means that the child can be admitted on the day of the operation and discharged on the same day after the operation.

What about activity after surgery?

The child can have normal activity. This does not affect the healing of the wound. The strenuous exercises should be avoided for 10-15 days.

When should the child follow up with the surgeon?

The child is usually seen in the outpatient department 5-7 days after surgery and the bandages are removed. The self-dissolving sutures are under the skin and dissolve on their own. A scar forms in the skin fold of the groin. As the child grows, the scar will fade, but never disappear completely.

What is the long-term outlook for this condition?

The incidence of recurrence after surgery is less than 1%. The incidence of recurrence increases if the surgery was performed in an emergency situation.

Is it possible to repair an inguinal hernia in children with laparoscopic or keyhole surgery?

Yes. It can be performed

What are the benefits of exploratory surgery for an inguinal hernia in children?

It is less traumatic for the child.

It allows the visualization of the opposite inguinal ring and if the ring is opened, it is possible to repair it in the same operation.

It is performed under magnification and therefore the incidence of injury to the vas deferens and testicular vessels is less.

There is minimal disruption of the lymphatic vessels and injury to veins and thus there is minimal postoperative swelling of the scrotum.

In girls, it is possible to evaluate the internal genital organs. In 1% of girls there may be an abnormality of these structures.

Does keyhole surgery have any disadvantages in the repair of an inguinal hernia?

General anesthesia techniques require intubation of the trachea with the endotracheal tube. And the theoretical risk of an increase in the incidence of recurrence from 1 to 3%. However, in the technique published by the author, the recurrence rate of laparoscopic inguinal hernia repair is almost zero.

Is there a need for mesh placement during surgery?

No mesh is needed in pediatric inguinal hernia repair.

REMEMBER

  • Inguinal hernias do not resolve on their own and require surgery to prevent complications.
  • The younger the child, the sooner it is needed.
  • If your child develops painful groin swelling, see a doctor as an emergency to avoid complications and morbidity.
  • After surgery, your child can play normally.

Dr. Rasik Shah

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