Childhood Inguinal Hernia
Introduction What are the symptoms and signs? What should I look for if I suspect the hernia is strangulated? What is the treatment for groin hernias in children? How long do children take to recover?Introduction top
These are relatively common in babies but may not become apparent until a child is much older. They are commonly caused by a failure of the peritoneum to obliterate (persistent patency of the processus vaginalis) when the testicles drop into the scrotal sac, although they can occur in girls as well. There are other rarer forms of groin hernia which can occur in infants as well such as femoral hernias.
The overall incidence of childhood hernia is between 1% and 5%. While this incidence is low, factors which increase the incidence include prematurity and low birth weight. The incidence can be as high as 13% in babies born before 32 weeks and almost 30% in babies with a birth weight below 1000g. They occur predominantly on the right (60%) and on both sides (bilateral in 10%).
What are the symptoms and signs? topThey become obvious as a bulge in the child’s groin, which is more apparent when they cry, strain or exercise. They should be repaired as early as possible because of the risk that intestines may become trapped in the hernial sac. This risk is as high as 30% in the first months of life.
What should I look for if I suspect the hernia is strangulated? top
Click to view pictureInfants typically present with inconsolable crying, poor feeding and eventually bile vomiting. Older children present with complaints of sudden and severe pain in the groin. The diagnosis is confirmed by the finding of a tender mass in the groin. Prior to any surgical exploration, your specialist may attempt to reduce the hernia with or without sedation. The decision to proceed to surgery thereafter is taken based on the condition of the child.
What is the treatment for groin hernias in children? topOpen surgery is performed simply by isolating and tying off the hernial sac with an absorbable stitch. Meshes are not used because they are not necessary. The incidence of bilateral hernias in children is relatively high, although only one side may be apparent on examination. During the operation, the other groin can be inspected laparoscopically using a fine 3mm telescope inserted through the hernial sac. If there is a hernia present then the other hernial sac is tied off during the same operation. In most children, the surgery is undertaken as a day case without the need for an overnight stay.
How long do children take to recover? topLimiting activity in children is difficult, but if the child is of school age then two weeks of avoiding physical education is appropriate. There will not be any stitches to removed as the wound will have been closed with a subcuticular absorbable suture under the skin. Showering and bathing can be performed normally as the wound is covered with a waterproof dressing.