What is Hernia?
Hernia is protrusion of part of belly (umbilical, inguinal etc.) because of weakness or defect in one of the muscle in abdominal wall.
What is inguinal hernia?
When this protrusion happens near the scrotum in inguinal region then it is called as inguinal hernia. When we are in mommy’s tummy (antenatally) there is small tunnel over the abdomen. In the boys this tunnel connects belly to scrotum and in girls it connects to labia. In addition in boys there is passage of testes from tummy to scrotum at the time of birth. Normally in all of us this tunnel has to be closed at the time of birth. When this tunnel doesn’t close then abdominal contents like intestine, omentum, ovary rarely some other parts poke through this defect in inguinal hernia. It appears as bulge in inguinal region. This bulge is not persistent it is on and off with the increase and decrease in pressure of tummy.
What is the cause of inguinal hernia?
There is no particular reason for development of inguinal hernia in majority of children.
What are the symptoms of hernia?
- Swelling or bulge in inguinal region
- Bulge is on and off mainly related to increase and decrease in pressure in tummy. Example while coughing, crying bulge will be more prominent, when child is sleeping the bulge disappears completely.
Will my child have pain because of hernia?
Generally there should not be any pain in children’s hernia. If there is pain in already existing hernia with swelling more prominent and painful on touch you should consult pediatric surgeon immediately.
How to diagnose inguinal hernia?
With the above mentioned symptoms and pediatric surgeon examines your child. He confirms on and off appearance of hernia. He will also palpate that area and feel thickened structures over there. Mostly diagnosis is clinical. Ultrasonography can confirm presence of hernia.
Does my child needs urgent surgery if diagnosed with inguinal hernia?
Surgery is required for your child to fix the hernia. Generally you can schedule it after consulting your pediatric surgeon. It will be like a day care surgery or one day admission.
My child doesn’t have pain, he is active and playful so what is the need of surgery?
All inguinal hernia needs surgery to fix it.
Let’s review classification of inguinal hernia to understand need of surgery.
Reducible inguinal hernia: Generally the bulge which is seen over inguinal area goes inside the abdomen either when someone pushes it inside or when the child is lying down. This is called as reducible inguinal hernia. Majority of children will have this type of hernia.
Irreducible inguinal hernia: Sometimes these contents of abdomen which have come outside like intestine, omentum cannot be pushed back. Child will have more pain, swelling will be prominent and there may be redness over swelling. When you touch the swelling it will be very painful. Smaller babies may cry excessively. They also may have vomiting. You have to see pediatric surgeon urgently. This stage is called as incarcerated hernia. What does it mean one of the contents of abdomen, intestine has come outside and is not going back inside. It is stucked. This part of intestine can lose blood supply, which will make your baby very sick. This stage is called as Strangulated hernia.
Inguinal hernia doesn’t close on its own. They will need surgery to fix them. To avoid above mentioned complications surgery has to be done. As of now there is no way we can come to know which are the children who will develop incarcerated hernia or strangulated hernia so we operate them to prevent these problems.
How I have to prepare myself and child for surgery?
Once you meet the pediatric surgeon, you can discuss with surgeon about the risks, benefits other alternatives and complications about surgery. At this point you can schedule the surgery. As this surgery will be done under general anaesthesia, you have to follow the instructions given to you by surgeon or pediatric anaesthetist about what to eat and not before surgery. Again you can talk to your surgeon whether it is an outpatient procedure or needs admission.
What kind of surgery will my child will undergo, an open or laparoscopic?
You can discuss with your surgeon about type of surgery he is planning.
In both surgeries general anaesthesia is given to child. In open technique a small incision is made over the inguinal region. All the contents which were popping out are pushed back and the defect in muscle is closed.
If it is a laparoscopic (keyhole) surgery, surgeon will make small incision near belly button and camera is passed through it. Two more small incisions are made on either side and surgery is done. Initially popping contents are pushed in and defect is repaired. Laparoscopy has advantage of repairing the other side also if it is there.
What are the risks involved in surgery?
Every anaesthetic carries the risk of complications but this will be very small. You can discuss with pediatric anaesthetist before surgery about this.
During surgery there can be damage to testicular cord and blood supply to testes as surgeon is separating these away from the passage. This risk is very small. Testes may become smaller or very rarely shrink in size in long term. You should not worry about fertility since other side testes is normal. There is possibility of infection which is managed with antibiotics. Sometimes there may be recurrence of hernia.
What happens once my child is discharged and how to manage at home?
You will be given discharge instructions in the leaflet. Generally child will be uncomfortable a day or two after surgery. Pain can be managed by paracetamol. Instructions should be given not have any rough activity, jumping or using toys like bicycle for few days. Do not give bath for 2-3 days. After that you can give shower, no need to rub the area. Dressing put over cut site will come off. Stitches which are given over cut are dissolvable, there is no need to remove them. You should schedule an appointment with your surgeon in a week. Generally child is ready to go to school in a week.