Inguinal (pronounced: ing-gwuh-nl) hernia repair is one of the most common operations that pediatric surgeons perform. It is typically an outpatient procedure performed under general anesthesia in children. The care and operation for inguinal hernias in children differs from that in adults.
A hernia is when there is a hole or weakness in the muscle layer of the abdominal wall. This means that organs or tissues inside the abdominal cavity can poke through the hole and cause the skin to bulge.
|What is an inguinal hernia?|
|Laparoscopic view of the left groin of a boy showing an inguinal hernia.|
|Laparoscopic view of the left groin of a boy showing no inguinal hernia.|
An inguinal hernia is a hernia that occurs in the groin region. In children these are almost all congenital hernias, meaning that the defect was present from the time the patient was born. Although the defect was always there, it may not become apparent until something bulges through the hole. Sometimes parents worry that their child lifted something too heavy or strained to hard to cause a hernia to develop, but in almost all cases this is not true. The hernia defect or hole was likely always there since birth. It was only the straining that pushed something through the hole to make it become noticeable.
During development in the womb, all babies normally form a short tunnel through the abdominal wall. In boys, this connects the abdominal cavity with the scrotum; in girls, this connects the abdominal cavity with the labia. This tunnel serves a purpose in boys. During development in the womb, the testicles initially grow inside the boy’s abdomen (Tummy), descend through this tunnel to end up in his scrotum. In both boys and girls, this tunnel is supposed to seal off prior to the baby being born. If it fails to close before birth, then the child is at risk of having an inguinal hernia. Given this, it is not surprising that inguinal hernias are more common in premature infants.
Most hernias are discovered by seeing or feeling the bulge. Parents or caregivers might be the first to notice although many times it is the pediatrician or other primary care provider who will find the hernia. In older children, the patient may be the first person to know that something is not quite right. When a hernia is suspected, the patient is referred to a surgeon to confirm the diagnosis and to discuss management plans with the family.
Despite all the high tech advances in health care, the diagnosis of a hernia is best made by a careful examination of the patient. While ultrasounds and various x-ray tests can be used to help determine if a hernia exists, they are rarely necessary and often add additional risks, stress and costs to the child’s care that can avoided by simply having the child examined by an experienced surgeon.
Before answering that question, it is important to understand how we classify hernias. Hernias fall into three categories.
Since inguinal hernias will not close on their own, generally all should be repaired. Of course, some children have health conditions that make surgery very risky, but for everyone else hernia repair is recommended. The main reason that hernias are fixed is to prevent the problems that can arise from incarceration or strangulation of the hernia.
During the initial meeting with the surgeon, he or she will review the child’s health, confirm the presence of a hernia, and determine if any additional testing is necessary prior to the repair. The surgeon will review the risks, benefits, alternatives, outcomes and complications of the various treatment options with the patient and family. If the patient requires surgery, a surgery can be scheduled at this appointment.
In children, these operations are performed under general anesthesia and are generally done as an outpatient procedure, meaning the patient comes in and goes home on the same day.
There are three different approaches to pediatric hernias.
|In babies and children, an open hernia repair just involves using stitches to close the defect. However, in some teenage patients a piece of mesh (shown here) is sewn into place to help strengthen the repair.|
After a hernia operation, the patient will have some pain. Many times this is controlled with over-the-counter pain medicines, but in some cases prescription pain medicine will be prescribed. The child may need to rest at home before returning to school for up to a week, and will likely have to refrain from full strenuous activities for a month.
Appointments and More Information
For more information, visit Pediatric General Surgery. To make an appointment or to ask questions, please call (727) -767-4170.
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