Inguinal Hernia
Inguinal hernia is the most common congenital anomaly seen in healthy children. Unlike adult hernias that represent a weakening of the abdominal wall, an inguinal hernia in a child occurs when the inguinal canal does not close completely after birth, leaving a path for intestines to enter.
Both girls and boys can develop hernias, although it is approximately nine times more common in little boys. An inguinal hernia appears as a bulge in the scrotum or groin area. Little girls will frequently demonstrate a bulge in the area of the groin or the labia majora. It is usually worse when the child cries or does anything that increases pressure in the abdomen.
Commonly, the bulge comes and goes and causes little or no discomfort to the child. However, it provides a risk that a loop of intestine might become entrapped outside of the abdominal cavity. If the intestine is tightly trapped, it will be cut off from its blood supply and quickly develop an infection that could be life-threatening.
If a child suddenly develops a tender mass in the groin or genital region that does not go away with gentle pressure, a physician should be consulted to determine whether surgical evaluation and often immediate operative intervention is required. Ninety-five percent of hernias are harmless bulges that may come and go, but these too represent potential risk. For this reason, every bulge in the groin or genitals should be evaluated by a pediatric surgeon to determine the type of hernia that may be present.
What can I expect regarding care?
The first inclination that a hernia is present often comes from the parent, who observes the bulge during diaper change or bathing, or the pediatrician who evaluates it during a routine well-baby physical. This usually requires referral to the pediatric surgeon, who, on initial examination, will review the child's medical history, especially in regard to whether the child was born prematurely. Premature babies have a slightly higher incidence of developing inguinal hernias and may also have a higher incidence of having the hernia on both sides at the same time, even though only one side is visible or has symptoms.
After a brief physical examination, the pediatric surgeon will describe to the family what the presence of a hernia means, as well as the process of repair, which, for the majority of infants, is done in an outpatient surgical center. The process usually involves evaluation by an anesthesiologist on the day of surgery, as well as review of the methods for pain control so that the baby has minimal or no pain after the operation.
How is the hernia corrected surgically?
The actual process of surgical correction does not change the strength or integrity of the abdominal wall. The opening in the inguinal canal simply needs to be closed with stitches. The part that extends into the scrotum is frequently removed to avoid postoperative or future swelling. The risks of the procedure are a very low possibility of significant bleeding and an even lower incidence of wound infection, which almost always spontaneously resolves within days. The vas deferens, which conducts sperm from the testis to the base of the penis, and the vessels that nourish the testis are very closely attached to this area and are potentially at risk for injury during the course of the procedure. For this reason, the operation is performed by fully-trained teams who recognize these anatomic relationships.
One question that continually arises is whether or not the opposite side should be considered for a surgical intervention at the time the original hernia is being repaired. Objective clinical evidence clearly indicates that if the opposite side has no symptoms of an inguinal hernia, it should not be considered for operative intervention. The chance that the other side will develop a hernia later on, requiring yet another visit to the surgeon and operative intervention, is extraordinarily low, occurring in about one in every 4,000-5,000 cases. For babies born prematurely or those in which there is concern that a hernia might be present on the other side, this may be addressed through surgical exploration or looking at the site through a laparoscope. Both of these options would be thoroughly reviewed and discussed with the patient's family before proceeding with any surgical care.
What kind of follow-up care is required?
Fortunately, once the inguinal hernia is repaired, the chances of further problems are less than 1 percent. The majority of children go home within hours of their procedure. The tiny incision in the groin is closed with sutures that gradually dissolve. In many cases today, this incision is closed by absorbable glue. After two or three days of keeping the area clean and dry, the baby can resume normal activity with the expectation of no further problems. Sometimes, there is brief swelling of the scrotum or testicle as the result of the surgery. This routinely disappears within weeks to months after the procedure.
|
