Inguinal Hernia (Pediatric)

What causes inguinal hernia? 

Inguinal hernia is the most common surgical problem of childhood. It results from a small sac that comes through the inguinal ring, which is normally open during fetal life and closes around the time of birth. For reasons we don't understand, it does not close in some infants. This more commonly happens when a baby is born early. This sac then makes a pathway for abdominal organs to come through the inguinal ring into the groin. In boys, the organ is usually a loop of bowel and, in girls, it may be bowel or an ovary. In boys and girls, the hernia first appears as a bulge in the groin, and may appear and disappear, or may be present all the time. It will usually "pop out" when the child cries or strains. If only fluid comes through the inguinal ring into the sac, the problem is called a hydrocele.  

How is inguinal hernia diagnosed? 

Inguinal hernias are diagnosed on physical examination by a doctor or nurse.  Rarely, ultrasound is ordered to identify inguinal hernia.  The pediatric surgeon does not require ultrasound to diagnose inguinal hernia. Sometimes, if inguinal hernia is not seen or felt on physical examination at the time of the initial clinic visit, your surgeon will ask you to take a photo of the “bulge” when it “pops out” to confirm the diagnosis.  

How is inguinal hernia treated? 

Inguinal hernias do not usually go away without treatment. Furthermore, if the sac is left open, a loop of bowel or other organ may become trapped or incarcerated (stuck) in the sac. Once trapped, the organ, which comes through this very small opening, can swell and compress the blood supply that is pulled along with it. Without adequate blood supply, the organ trapped in the hernia sac can become damaged or even die (a condition called strangulation). If your child has an incarcerated hernia, he or she may have a hard, red, painful lump in the groin area, may vomit, may be unwilling to eat, and may stop stooling. This is an emergency. If this happens, your child should be taken to your pediatrician's office or, after hours, to the local emergency room. The pediatrician or emergency room doctors will contact us. If the hernia cannot be pushed back (reduced) into the abdominal cavity, your child will need immediate surgery. 

Your child's pediatric surgeon will close the opening to the hernia sac either laparoscopically, or with “open” operation.  Laparoscopy involves small instruments through 2 or 3 tiny incisions, using the SEAL technique (see the figure). “Open” operation involves a very small (about one inch) incision in the groin. The pediatric surgeon will tell you which approach is best for your child. Children less than one year of age, can have an open sac on the other side that could become a hernia later. Your child's surgeon may use a tiny telescope to look for a hernia on the opposite side and close it if there is one. The surgeon will discuss this with you before the operation. There will be no stitches to remove from the skin later because the stitches will all be under the skin and will dissolve on their own.  

How long will my child stay in the hospital? 

After the operation your child will return back to the recovery area, and you can be with him or her while he or she is waking up. Some children are upset and confused as the anesthesia starts wearing off. This is temporary and not unusual. Most children will go home on the same day as soon as they are awake and able to drink liquids after the operation. If your child was born prematurely, or has other health problems, the surgeon may keep him or her in the hospital overnight to monitor his or her breathing.  After surgery, your child will only need Tylenolâ  or ibuprofen for a couple days to treat any discomfort or pain.   

What is expected after surgery? 

Swelling at the scrotum or incision site is common after surgery. The swelling will resolve after a couple of weeks. However, after surgery, there is very small risk of the hernia recurring.  If you notice a bulge at the groin or scrotum after surgery, you should contact the pediatric surgery office for evaluation.