An inguinal hernia is the protrusion of some of the contents of the abdomen into the groin area. They occur in 2% of all children but are more common in boys as there is a passage created by the descent of the testis from the abdomen into the scrotum during the fetal period. If this passage remains open after birth, some fat or a loop of bowel can pass from the abdomen into the groin and even into scrotum. In girls the hernia may contain one of the ovaries.
Childhood inguinal hernias are treated with surgery. The aim of the operation is the division of the communication between the abdomen and the scrotum. Unlike adults, mesh is not required. The operation is performed under general anaesthesia. Your child will usually not have to stay overnight in hospital.
Hernias do not go away on their own and if they are not fixed, are at risk of getting stuck. This can be painful for the child and can damage both the testis and content of the hernia, including the intestine. Risk is especially high in infants under a year of age and hence inguinal hernias in very young children should be repaired as soon as they are diagnosed.
Your child cannot eat for 6 hours before the procedure. In breast fed babies this time may be reduced by the anaesthetist. Your child can drink water for up to 2 hours before the operation. The Day Surgery Unit will instruct you the day before surgery to confirm fasting times. It is useful to bring your child’s favourite toy along on the day.
The anaesthetist will meet you and your child prior to the procedure. They will discuss the anaesthetic with you and take you through to the operating theatre. Your child will be anaesthetised using a face mask and then you will be taken to a waiting area. Once your child is asleep a drip is inserted often in the hand or arm, but occasionally it may need to be sited in the leg.
The operation is done through an incision in the groin. The communication between the abdomen and scrotum is found and in boys it is carefully peeled off the sperm tube and the blood vessels to the testis. The communication is then divided and closed after pushing any contents back into the tummy cavity. Local anaesthetic is infiltrated to numb the area. The wound is closed with absorbable sutures which are under the skin. Tissue glue is applied as a dressing. It is lilac in colour and takes 2 weeks to fall away. The whole operation takes around 30 minutes.
On completion of the operation your child will be taken to the recovery area. Children often initially appear distressed and a little confused upon waking up but will quickly settle down once you are with them and if offered a drink or something to eat. Full recovery usually takes about 2-3 hours after which you can go home.
Children’s paracetamol should be given for pain relief for 24 hours. After that use paracetamol only if needed. Some children need additional medication such as ibuprofen or celecoxib. Opiate (morphine-type) medications are not usually required. Paracetamol and ibuprofen can be given at the same time and work well together. Follow the dosages recommended on the packaging or by the anaesthetist. Never give more than has been prescribed.
It is quite normal for the scrotum (boys) or labia (girls) on the side of the hernia to look swollen and there may be some bruising. This usually resolves in week or so.
In general, your child may eat a normal diet after surgery. Vomiting is common on the day of surgery. It is temporary, and usually due to the anaesthetic and pain-relief medications that are used. If vomiting occurs, start with clear liquids and add solids slowly for the first day.
I will review your child 4-6 weeks after the surgery to ensure healing of the wound. For patients from rural areas this may be deferred to your local General Practitioner or Paediatrician. Please ring soon after the operation to arrange a convenient time.
This is a common operation with a low complication rate. The vast majority of children who have this operation recover well and have no serious complications of surgery. However, complications can occur. Some of the recognised ones include:
The chance of recurrence is <1%. The recurrent hernia will show up as a lump in the groin. If the hernia recurs further surgery will be required to correct it.
Infection & Bleeding
There is a 1-2% risk of bleeding or wound infection after surgery. The wound will appear red, be tender to touch and may discharge pus or blood. If this occurs, a course of antibiotics may be required, and you should contact me or present to your General Practitioner or Local Hospital as soon as possible.
Damage to Testicular Vessels
There is a <1% chance of damage to the testicular vessels. This occurs more commonly when repairing recurrent hernias and may result in loss of function and/or shrinkage or disappearance of the testis over a few weeks.
Damage to the Vas Deferens
There is a <1% chance of dividing or damaging the vas deferens. This tube takes sperm from the testis to the penis during emission and ejaculation. If it is damaged, the testis can be rendered non-functional as a reproductive organ.
Hernia on the Opposite Side
There is a 5-20% chance of the hernia occurring on the opposite side. It is not possible to predict this with any reliability, it is unrelated to the initial hernia or operation, and if it occurs will need a further operation.
This is not a reason to do a preventative exploration or repair when fixing the first hernia as it risks all of the above complications for a problem that may not exist.
Please refer to the following resources for more information:
This page is intended to provide you with information and does not contain all known facts about inguinal hernias. Treatment may have uncommon risks not discussed here. Please do not hesitate to ask any questions you may have.