Inguinal hernia is the most common surgical problem of childhood. It results from a small sac that comes through the inguinal ring that is normally open during fetal life and closes around the time of birth. In some infants, it does not close. 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.
Inguinal Hernia surgery
Inguinal hernias never go away without treatment. Furthermore, if the sac is left open, a loop of bowel or other organ may become trapped or incarcerated (strangulated) 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. If your child has an incarcerated hernia, he or she may have a hard, red, painful lump, may vomit, may be unwilling to eat and may stop stooling. This is an emergency. If the hernia cannot be pushed back (reduced) into the abdominal cavity, your child will need immediate surgery.
What does the surgery involve?
In some children, the hernia sac will need to be closed through a very small (about 1-2 cm) incision in the groin. This is called an “open” inguinal hernia repair. Children less than one year of age, can have an open sac on the other side that could become a hernia later, and so the surgeon may propose to explore the other side during the same anesthesia, and correct the hernia if there is one.
Your child’s pediatric surgeon might also close the opening to the hernia sac laparoscopically, using small instruments through 3 tiny incisions. (5 mm Umbilical incision, and two smaller incisions on the abdomen of 3 mm). This is called the “Laparoscopic” inguinal hernia repair. One of the advantages of Laparoscopic inguinal hernia repair is that the surgeon can easily look for a hernia on the opposite side and close it if there is one.