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Inguinal Hernia

Inguinal hernias in children are different than hernias that occur in adults. They are congenital, which means they are present at birth.

The inguinal canal extends down the groin toward the scrotum (in boys) or the labia (in girls). This canal will normally close on its own. If it does not close completely, and if this opening is large enough, the intestine or even an ovary can come into the canal. This creates a bulge noticeable in the groin region. This bulge is called a hernia. The contents that may be in the hernia sac can sometimes go back and forth from the abdomen, and there is usually no problem unless they get stuck.

If fluid travels down this opening, it is referred to as a hydrocele.

What causes an inguinal hernia and who is affected?

Inguinal herniaA hernia can develop in the first few months after the baby is born because of a weakness in the muscles of the abdomen. They will often occur in children whose inguinal canals do not close after testicles have come into the scrotum or in males whose testicles are undescended. Although girls do not have testicles, they do have an inguinal canal, so they can develop hernias in this area as well.

Hernias are most common in boys, but can also occur in girls.

Inguinal hernias occur:

  • In 1 to 3 percent of full term infants
  • Three times more often in premature infants
  • In children who have a family history of inguinal hernias
  • More often in infants and children with other urogenital anomalies.

Hernias occur more often in children who have one or more of the following risk factors:

What are the symptoms of an inguinal hernia?

Hernias usually occur in newborns, but may not be noticeable for several weeks or months after birth. Straining and crying do not cause hernias; however, the increased pressure in the abdomen can make a hernia more noticeable.

Inguinal hernias appear as a bulge or swelling in the groin or scrotum. The swelling may be more noticeable when the baby cries, and may get smaller or go away when the baby relaxes. If the bulge is pushed on gently when the child is calm it should get smaller or go back into the abdomen, known as reducing the hernia.

Is an inguinal hernia dangerous?

Occasionally, body parts that protrude through a hernia, such as the loop of intestine or an ovary, may become stuck, and the hernia is no longer “reducible.” This means that the hernia cannot be gently pushed back into the abdominal cavity as it can be at all other times. When this happens, these body parts inside the hernia may lose their blood supply. A good blood supply is necessary for these body parts to be healthy and function properly. This is called an incarcerated hernia and requires immediate medical attention. If a hernia is no longer reducible, is hard, very painful, red or swollen, if the abdomen is distended, or if the child is vomiting, seek medical attention immediately.

Can I try to reduce an inguinal hernia?

If your child is not in discomfort and the bulge is incidentally discovered, you can try to reduce it. Your child should be in a warm, comfortable position and lying down. Sometimes simple relaxation will cause it to reduce spontaneously. Otherwise, you may try to push the bulge back into the abdomen with gentle pressure upward along the groin. There will be no harm from trying to push it into the abdomen. Do not worry if it is easily reduced and happens to slide back out. Seek medical attention if there are symptoms and pain associated with the hernia and it is difficult to push inward or cannot be reduced.

When should an inguinal hernia be repaired?

If the hernia is reducible, it can be repaired electively. If it is stuck, an attempt should be made by a physician to reduce the hernia. If it is reduced, it should be repaired semi-electively, meaning within a few days. If it cannot be reduced by a physician, it should be emergently repaired because of the problems previously mentioned. We recommend repair of all groin hernias regardless of age.

How do you repair an inguinal hernia?

An inguinal hernia is repaired with surgery. Your child should not eat or drink prior to the surgery. Your child will have general anesthesia and will not feel any pain during surgery. The surgery usually takes one hour. An incision is made in the lower abdomen along a skin crease. The hernia sac is separated from the blood vessels and spermatic cord (in boys) and traced to the inner abdomen where it originated. A stitch is placed there to close that opening. Sometimes, in boys, the portion of the sac going down toward the scrotum is dissected to fix a hydrocele which is filled with fluid. Once this is repaired, the wound is closed with absorbable stitches and has a sterile dressing. A local anesthetic is injected into the wound to east post-operative pain.

Do you repair both sides?

Children under one year of age often have both sides repaired. There is a high incidence of having a hernia on the other side, especially in girls. Normally the opposite side can be assessed laparoscopically. If a hernia is seen, it will be repaired at the same time.

When will my child go home?

The surgery is performed as an outpatient procedure for children older than three months of age. After surgery, your child will go to the recovery room. Most children go home on the same day. If your child is less than 52 weeks post conceptual age, and is a prematurely born infant, they will be watched overnight in the hospital on an apnea monitor for safety.

Can an inguinal hernia come back?

The recurrence rate of a pediatric hernia is very low. If this area has a bulge in later life, it may be an adult type of hernia. This type usually involves a weak muscle floor and not an opening that has been there since birth. Infants and children do not have a weak muscle floor.

Post-operative Care Instructions

The below instructions are general guidelines. Specific changes or instructions for your child may differ and are intended for CHOC Children’s patients. Please follow instructions given to you by your surgeon.

Thank you for choosing CHOC Children’s for surgery. Hernia procedures are performed in an operating room and are normally completed on an outpatient basis, and do not require an overnight in the hospital.

Diet

Patients only consume clear liquids immediately after surgery and then progress to a regular diet as tolerated. The anesthesia can cause some stomach discomfort and nausea.

Pain Management

Patients may be sent home with Tylenol #3 to be taken as needed for pain. Most children need it for one to three days. If the doctor prescribed Tylenol #3 (with codeine) tablet or elixir, please try to give it to your child as little as possible because codeine can cause constipation, which can be painful. Miralax is an over the counter stool softener and can be used to relieve constipation if it occurs. Whenever possible, try to use Ibuprofen (also known as Motrin or Advil) instead of the Tylenol #3. Do not take Tylenol #3 and Tylenol at the same time – this can be an overdose and is harmful. If needed, Ibuprofen and ONE Tylenol product can be taken within the same time period. Should you have questions regarding dosage and timing of pain medication after surgery, please contact our office. To reduce swelling and discomfort, you may place a sandwich bag full of ice covered in a cloth or towel over the surgical area. Never apply ice directly to the skin.

Incision Care

Your child may be placed in the bath or a swimming pool 24 hours after surgery. The dressing may or may not come off on its own, and either way is fine. Swelling and bruising are normal, especially near the incision on the abdomen or the scrotum. It is normal for the incision to be pinkish or red; however, if it becomes very red or dark red and/or has pus, please call your surgeon’s office. The clear bandage on top is called “Tegaderm,” and the little cloth-like bandages underneath are called “steri-strips.” Sometimes there is a little blood that has soaked through the steri-strips, which is normal. Often a gray material (surgical glue) will be over the incision area and will fall off on its own. The stitches will dissolve on their own in about two weeks.

Testicles

After surgery, try to be mindful of the position of the patient’s testicles. They should be in the base of the scrotum; however, sometimes after surgery involving an inguinal incision, it is possible for scar tissue to develop and “tug” the testicle upwards. At each diaper change, or three to four times each day, make sure that you can gently pull the testicle down into the base of the scrotum. Older children can do it themselves.

Activity Restrictions

For two to three weeks after the surgery, your child should avoid trauma to the surgical area and avoid rough-housing, contact sports, bicycle riding or physical education. Younger children should avoid walkers or straddle toys like bouncy chairs and jumpers or rocking horses. At your child’s follow-up appointment, about one week after surgery, our staff will provide more specific directions as to when it is safe to return to activities. Most children are able to return to school within a few days of surgery, as tolerated.

For more information on how to prepare children of all ages for surgery and what to expect the day of the procedure, please read our comprehensive surgery guide.

To schedule a consultation with a CHOC Children’s pediatric surgeon, please call 714-364-4050.

To schedule a consultation with a CHOC Children’s urological surgeon, please call 714-509-3919.

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CHOC Children's is affiliated with the UC Irvine School of Medicine