Inguinal Hernia in Children and Its Treatment

Inguinal hernia is one of the most common congenital issues in infants and children. In male babies, the testes, initially located inside their abdomen, descend through the inguinal canal into the scrotum as pregnancy progresses. This sac (processus vaginalis) originating from the peritoneum within the inguinal canal closes naturally at birth. However, when it doesn't close, the internal organs entering this canal and the resulting pressure lead to what we call an inguinal hernia (indirect hernia).

Having a history of inguinal hernia in twins or other family members increases the risk of developing an inguinal hernia. Statistics show that the likelihood of inguinal hernia in family members of patients with the condition is 11.5%. Exposure to conditions that increase intra-abdominal pressure, such as constipation, fever, cough, and vomiting, can also trigger an inguinal hernia. We address this crucial topic for babies and their families with expert insights. Details are provided by Dr. Ahmet Nadir Tosyalı, Pediatric Surgeon at Anadolu Health Center…

WHAT ARE THE INITIAL SYMPTOMS?

The preliminary diagnosis of inguinal hernia, indicated by symptoms such as swelling in the groin or scrotum, discomfort, and sometimes vomiting, is often made by the families. Children are occasionally brought to the clinic with complaints of swelling in the right or left groin areas (60% of inguinal hernia cases are on the right side, 30% on the left side, and 10% are bilateral). This swelling appears during activities that increase intra-abdominal pressure, such as straining, crying, and coughing, and usually disappears with rest. In advanced cases, the swelling fills the scrotum, and older children may experience groin pain, especially during physical activity and exercise. In newborns, symptoms like reluctance to feed and restlessness may be observed.

WHAT AGE RANGES ARE MORE COMMONLY AFFECTED?

Indirect inguinal hernia, caused by the entry of intra-abdominal organs into the peritoneum-derived sac, is seen in 1-5% of children. This rate rises to 30% in premature infants. While it is more frequently seen in the first months after birth, the majority of cases are under 1 year of age. In adults, it appears more commonly after the age of 50. Approximately 28-30% of men and 2-3% of women are estimated to experience an inguinal hernia at some point in their lives.

WHAT IS DONE DURING DIAGNOSIS?

A thorough history taking, careful and patient general physical examination including the genital area, and ultrasonographic examination when necessary can easily confirm the diagnosis. It should be noted that 30-60% of cases are diagnosed within the first six months.

SURGERY IS THE ONLY OPTION FOR TREATMENT

Inguinal hernias are treated only through surgical methods, and this repair is one of the most frequently performed surgical procedures in pediatric surgery clinics. Surgeries can be performed using either the classic open or laparoscopic method. In the open method, a small horizontal incision is made in the groin area, and the hernia sac is repaired using a high-ligation technique. In the laparoscopic method, the surgery is performed with instruments and a camera inserted through one or 2-3 small incisions made in the abdominal wall. Hospitalization is not required. Babies operated on in the morning are discharged in the late afternoon. Infants aged 0-12 months return to normal within 3-4 hours post-surgery, while this period is only 1-2 days for older children. It is important to avoid heavy lifting for a certain period (6-8 weeks) after surgery, consume fiber-rich foods to prevent constipation, and avoid excessive strain.

Does an inguinal hernia heal on its own?

No, it does not. Additionally, the timing and location of potential risks and dangers cannot be predicted. Therefore, inguinal hernias must be treated when diagnosed.

Can an inguinal hernia recur?

There is always a possibility of hernia recurrence after surgery. However, the recurrence rate in children after surgery is less than 1%. Recurrence may occur due to surgical technique deficiencies or structural connective tissue disorders in the patient.

What is hernia incarceration?

Incarceration (hernia strangulation) occurs when the organs within the hernia sac cannot easily return to the abdominal cavity. If the blood supply to these organs is compromised and necrosis occurs, this is referred to as "strangulation." Both conditions are known risks of inguinal hernia and require urgent intervention.