What Does Hernia Mean?

There are different cavities in our body (such as the chest and abdominal cavities). The organs in these cavities cannot pass from one to another due to some anatomical structures. For example, intra-abdominal organs cannot pass into the chest cavity. The general definition of hernia is hernia when organs move to different cavities or move outside the body due to a defect (opening) in the anatomical structures that prevent this passage.

What is Inguinal Hernia?

It is the protrusion of an organ or organs in the abdomen (such as intestines, appendix, ovary in girls) through the abdominal wall through an opening formed in the groin area.

How Does Inguinal Hernia Form in Children?

During the development of the baby in the womb, the testicles, called testicles in boys, first begin to form and develop in the upper pole of the kidneys, then migrate into the abdomen, pass through the inguinal canal and descend into the bags called the scrotum. In girls, the ovaries remain in the abdomen, but in girls, one of the ligaments that help the uterus stay fixed in the abdomen (round ligament) passes through the inguinal canal and is responsible for preventing the uterus from bending backwards. These formations passing through the inguinal canal also drag the peritoneum, which covers the abdominal organs, along with them. This descent occurs in the last months of pregnancy. This membrane closes after the passage is complete, but it does not close in 10% of babies. If it does not close, a number of diseases occur. If the opening is wide and the abdominal organs protrude through the abdominal wall, an inguinal hernia occurs. The exact reason why this membrane does not close is not known.

 

Figure: a- Normal development, b- Formed due to membrane failure, Inguinal Hernia

What are the Symptoms of Inguinal Hernia in Children?

The important finding in this disorder, that is, the suspicious situation, is the swellings that appear and disappear in the groin area of ​​the baby or child. It is possible to see it on the right, left or both sides of the groin area. In male babies, the swelling that starts from the groin can go down to the bags. In female babies, the swelling can be seen in an area that goes down to the anatomical area called the labi mayor. In babies, the swelling in the groin area can be seen more clearly in situations that will increase the pressure in the abdomen, such as straining, crying, coughing. These swellings may also disappear when the increase in pressure in the abdomen decreases. Inguinal hernia that is very advanced can go down to the bags in male children and can even come to the testicle.

 

Figures: Images of Inguinal Hernia in Boys and Girls

Figure; Right Inguinal Hernia, swelling in the right scrotum and groin area is seen.

Who is Inguinal Hernia More Common in Children?

It is more common in male babies, low-birth-weight babies, premature babies, in vitro fertilization and children with some congenital connective tissue diseases. It is a condition that is 5-6 times more common in boys than in girls. According to the figures, inguinal hernia occurs in approximately 3-4 out of every 100 boys.

There is no specific age for inguinal hernia to occur, it can be seen in individuals, children and babies of all ages. It can be seen in a one-day-old baby or it can show itself in older ages.

Is Inguinal Hernia in Children Familial?

If the mother, father and siblings have inguinal hernia, the frequency of occurrence in other siblings is higher than normal. However, we cannot definitely say that it is familial or genetic.

Does an Inguinal Hernia Go Away on Its Own?

No, but it can be surgically corrected.

What Kind of Problems Can Occur When an Inguinal Hernia Is Not Operated?

When an inguinal hernia is not operated on, the hernia can become strangulated. In other words, the organs that protrude cannot go back in on their own. In this case, the blood supply to the organs is disrupted and partial or total organ loss may occur. For example, if the intestines become strangulated, partial intestinal loss may occur, and if the ovaries become strangulated in girls, total ovarian loss may occur.

How is Inguinal Hernia Surgery Performed in Children?

It can be performed with open method or laparoscopic (closed) method.

The procedure is performed under general anesthesia in the operating room.

What is Done Before Inguinal Hernia Surgery?

First of all, a good history should be taken and a general physical examination should be performed, and only the groin area examination should not be sufficient. Then, the family (mother and father) is well informed about the process, that is, before the surgery, the surgery process and after. If the child is older, the child is also included in this. A number of tests are performed, these tests are not general and are determined according to the patient. The patient is also seen by the anesthesiologist, the family and the child are informed about the anesthesia process that will be experienced. The patient is left fasting for 4 hours before the surgery.

What is the Recovery Process Like After Inguinal Hernia Surgery in Children?

The patient is fed according to the doctor and/or nurse's directions 2 hours after the surgery. Babies over 2 years old can be sent home after 4-6 hours. Newborns may need to stay in the hospital for 1 day. After the operation, the patient only takes painkillers according to the doctor's recommendations, there is no need to take additional medication. The patient is seen by the doctor after 48-72 hours, during which time there is no need for dressing, the stitches dissolve on their own and do not need to be removed. The patient continues his normal active life according to the doctor's recommendations after the operation.

What is Inguinal Hernia Most Commonly Confused With in Children?

In boys, Hydrocele, which we call Water Hernia, can be confused with lymph nodes in the groin area in girls. The distinction is very important. Because the treatment process of all three conditions (Hernia, Water Hernia and Lymph Node) is completely different.

Can Inguinal Hernia Be Performed Laparoscopically (Closed) in Children?

Yes, it can be done.

What are the advantages of Inguinal Hernia Surgery in Children with Laparoscopic (Closed) Surgery?

The surgery takes less time, there is no visible scar, since the inside of the abdomen is seen completely, it is evaluated on the opposite side where there is no hernia and possible hernias can be prevented.

How is Inguinal Hernia Performed Laparoscopically (Closed) in Children?

A 3 or 5 mm optic (camera) is inserted from the navel. Thus, the hernia is seen in the abdomen. The hernia surgery is performed with threads passed through a needle (1-2 mm) entered from the groin area.

Is There a Different Situation After Inguinal Hernia Laparoscopic (Closed) Surgery in Children?

No, the same things that are valid in open surgery are also valid for Laparoscopy. In fact, the patient has a more comfortable period afterwards. Complications such as bleeding and wound infection are much less common.

What are the Complications of Laparoscopic (Closed) Inguinal Hernia Surgery in Children?

When performed by reliable and experienced hands, it can be said that there are no complications. However, it should not be forgotten that laparoscopy requires more knowledge and experience than open surgeries. If the person performing it does not have enough experience, more serious complications can be seen compared to open surgery. These complications are: bleeding and even major and life-threatening major vessel injury, Injury to vital organs that are hollow (lumened), especially the intestines.

What are the advantages of closed inguinal hernia surgery?

• Since it does not require an incision in the groin area, there is no scar.
• Since it does not require an incision, the pain the patient will feel is much less than open surgery.
• One of the most important advantages of closed inguinal hernia repair is that the other inguinal canal, which is not swollen, can be seen during the procedure. In this way, if there is a problem in the other groin, it can be treated in the same surgery.
• In open surgery performed in boys, it may be necessary to hold and sometimes pull the hernia sac to separate it from the testicular vessels and sperm duct, but since the hernia sac is not removed in closed surgery, the testicular vessels or sperm duct are not touched at all. Therefore, complications that may occur in the testicle are eliminated.
• In recurrent inguinal hernia, the gold standard for treatment is closed surgery.
• The surgery is performed from a cleaner area and thus possible wound infections are prevented.
• Closed inguinal hernia surgery takes less time than open surgery and therefore the amount of anesthesia the patient will receive is less.
• The duration of hospitalization is shortened.

!!! However, it should not be forgotten that closed (laparoscopic) surgeries require more knowledge and experience. Lack of knowledge and experience can cause serious organ injuries and irreversible complications.

Can circumcision be performed at the same time as inguinal hernia surgery?

As long as the surgery does not take longer, circumcision can also be performed. The process is the same, it does not impose an additional burden on the patient

Is there pain after inguinal hernia?

During inguinal hernia surgery, the patient is definitely given painkillers and if painkillers are used for 3-4 days after the surgery in accordance with the recommendation of your doctor, there will definitely be no pain.

***The information provided here and the content of the website are arranged for the purpose of informing visitors, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. Families should definitely have their patients examined by a pediatric surgeon and make a decision based on their personal knowledge and experience.