Hernia and Hydrocele InformationHydroceleA hydrocele is a collection of watery fluid around the testicle. This is a common problem in newborn males and usually goes away within the first year of life. When the testicle drops into the scrotum before birth, a sac usually closes off and the fluid is absorbed. Sometimes the sac persists creating a communicating hydrocele allowing fluid to flow freely between the sac and abdomen. Sometimes the sac closes but the fluid fails to be absorbed creating a non-communicating hydrocele. A hydrocele may not be in the scrotum but higher up in the spermatic cord. In unusual instances the hydrocele fluid can be the result of an abdominal inflammation or testicular problem (injury, torsion, infection, tumor). A persisting communicating hydrocele is evidence of a hernia and should be fixed. A very large or symptomatic hydrocele should be fixed. If the hydrocele is suggestive of tumor or torsion, urgent exploration is performed. A large non-communicating hydrocele persisting after 1 year of age is unlikely to go away and should also be fixed. HerniaThe extension of the abdominal sac that passes into the groin is called the processus vaginalis. This usually closes off by the time of birth. If it remains open, fluid can pass down into the groin and scrotum in boys to form a hydrocele. If the sac is wide enough it can allow other abdominal contents such as intestine or fat (in girls, tube or ovary as well) to travel down it. These structures can pass in and out of the hernia sac, but sometimes get stuck (incarcerated hernia). Hernia repair is a common surgical procedure in children. One out of every 150 boys and 850 girls has a hernia. Hernias favor the right side, but may occur on both sides. The incidence is much higher in premature babies. The usual hernia is a lump or bulge in the groin or scrotum. Usually asymptomatic, the hernia can cause pain, fussiness, or even bowel obstruction. Although hernia contents usually pass back into the abdomen intermittently (reduction of the hernia) the sac itself does not disappear; therefore, a hernia should be fixed surgically. Most are repaired electively. Incarceration may cause much distress, and when this happens and the hernia cannot be reduced, urgent surgical correction is necessary. If a hernia becomes strangulated, the involved intestine will die and have to be removed. This is a life-threatening situation. Correction of Hernia/HydroceleHernia repair is done under general anesthesia. Sometimes local and/or caudal blocks are placed to help with pain control. The anesthesiologist will discuss these options with you prior to surgery. The hernia is approached through a one-inch incision in the groin. The sac is separated from the spermatic cord vessels and vas deferens and then tied off where it originates from the abdominal cavity. Pediatric hernias (indirect inguinal hernias) are usually different from adult types (direct inguinal hernias) which tend to have a muscle weakness that must be fixed. Muscle repair is rarely necessary for pediatric hernias. Hernia complications, in addition to bleeding, infection, and recurrence include hydrocele formation, injury to the spermatic cord vessels and damage to the vas deferens. With any groin or scrotal operation there is always a small chance that the testicle could be damaged or lost. The surgeon will make a small incision on the side with the hernia and may then place a small scope or camera through the incision to see if there is a hernia on the opposite side. Approximately 30% of the time a hernia on the opposite side will be found. If found, the opposite side will also be repaired through a second small incision on that side. About the OperationYou and your child come to the hospital on the day of the surgery, have the operation and go home the same day. The operation itself takes approximately one hour. You will be at the hospital for approximately four to six hours. Children with certain medical problems or prematurity may be required to spend the night after surgery. After the Operation
What restrictions will my child have after the surgery?Your child can return to normal activity or school the next day, but should avoid vigorous physical activity (gym class, tree climbing) for 2-4 weeks. Your child should also avoid lifting anything greater than 10 pounds for one month after surgery. There are no restrictions for infants. Will my child have pain?Most children do not have severe pain after inguinal hernia repair. Most often over-the-counter pain relievers (ie. Children's Tylenol or Children's Advil) are adequate for pain control. Often we will provide you with a prescription for Tylenol with Codeine for more severe pain. Do NOT mix a dose of regular Tylenol for Children and a dose of Tylenol with Codeine - this may be too much Tylenol and could be harmful. Remember that codeine may make your child drowsy, nauseated, or constipated. Have your child take the codeine with food and encourage them to drink plenty of liquids. Teenagers should not drive or operate heavy machinery while taking codeine. When should I call to speak with a nurse?If your child has:
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This information is provided by the University of Michigan Department of Surgery, Section of Pediatric Surgery and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider or our offices. |
