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Inguinal Hernia/Hydrocele

Inguinal Hernia

What is an Inguinal hernia?

An inguinal hernia is a common condition in infancy and childhood, and is the most common surgical operation in childhood. An inguinal hernia occurs when tissue or part of the intestine pushes through a weak spot in the abdominal wall in the groin area, causing a bulge in the groin or scrotum.

What causes an inguinal hernia?

An (indirect) inguinal hernia is caused by an opening in the inguinal canal that does not close as it should before birth. This allows abdominal tissue to push through the lower abdominal muscles. The occurrence of inguinal hernia and undescended testes is related to the developmental events that result in the formation of the processus vaginalis and the descent of the testicles into the scrotum. These events occur at 3 months gestational age related to hormonal influences that allow the testis to descend into the scrotum. The testicles are attached to a structure called the gubernaculum. This structure is responsible for passing through the internal ring and inguinal canal of the abdominal wall and extending into the scrotum. As this developmental process takes place the testicles come through the internal inguinal ring, a portion of the peritoneum (this portion is the processus vaginalis) and through the ring of the inguinal canal. When this formation takes place the processus vaginalis is pulled with the testis and forms the sacs. In most children this sac closes on its own, when these structures fail to close this can lead to either: (1) An inguinal of scrotal hernia- this occurs when the sac is open to wide and allows the intestine to enter, and/or (2) fluid can pass down into the groin and scrotum in boys to form a hydrocele- or if the sac is wide enough it can allow abdominal contents such as intestine or fat to travel down (or in girls an ovary or tube).

Incidence

Inguinal hernias account for about 80% of all hernias and are the most common surgical procedures done in infancy. These hernias appear more frequently in boys than in girls. Approximately 3% to 5% of term infants may be born with a clinically apparent inguinal hernia. Premature infants have a higher incidence. Inguinal hernias are most often on the right side (60% of the time). Inguinal hernias are more common in boys; however girls may present with bilateral hernias in more cases.

Normal scrotum:
the processus vaginalis and tunica vaginalis are closed and contain no fluid or abdominal contents
Inguinal hernia:
the processus vaginalis has remained open allowing abdominal contents (fluid and loops of bowel) to enter into the scrotum

What does a hernia look like?

Most families notice a bulge in boys in the groin or scrotal sac. The bulge may be more noticeable during crying or straining and can come and go. The bulge may also reduce back into the groin or scrotal area. In girls, parents may notice a bulge in the upper portion of the labia. At times it may be difficult to locate the hernia and the physician may ask the parents to re-examine the child another day; or to ask parents to photograph the bulge. The surgeon will always document and examine the presence of the hernia prior to the operation. The diagnosis of inguinal hernia is usually based on your medical history and a physical exam.

Complications of a hernia

If the parents notice that any discoloration in the area of the hernia occurs they need to follow up to the Emergency room immediately. Hernias usually do not cause pain; and if your child seems to be in distress and the hernia does not reduce- urgent surgical correction is needed. An infant or a child will show signs of irritability, loss of appetite, tenderness and swelling of the abdomen or have trouble having a bowel movement. With incarceration, the intestines have entered the sac and are being strangled. This portion of the intestines could die. This is life-threatening and you should call right away.

How is the hernia surgically repaired?

In most cases, inguinal hernia repair is done in the outpatient setting. The operation takes approximately one hour; although you will be in the hospital for four to five hours. Children with chronic medical conditions may also need to be admitted over night for observation. Hernia repair is done under general anesthesia. At times, local or caudal blocks are also placed to help with pain control. The anesthesiologist will meet with you prior to surgery to discuss these options with the family. A one-inch incision is made in the groin to approach the hernia. The sac is carefully separated from the spermatic cord vessels and vas deferens and then tied off where it originated from the abdominal cavity. Hernia complications include bleeding, infection, scarring, recurrence, need for additional procedures, hydrocele formation, injury to the spermatic cord vessels, and damage to the vas deferens.

With any type of groin or scrotal operation there is always a small chance that the testicle could be damaged or lost. The surgeon may also place a small scope or camera through the incision and check to examine if there is a hernia on the opposite side. If a hernia is found that side will also be repaired using the same technique. The sutures below the skin will all dissolve, no stitches need to be removed. There may be a clear substance over the surgical site or steri-strips (surgical tape) on the site. These do not need to be removed; these will fall off in seven days. Your child should refrain from tub baths/swimming for seven days, in order to avoid submersion into water at the surgical site. Your child may shower in 48 hours from the operation. Also it is common for your child to have mild swelling or bruising in the scrotum, this should resolve in several weeks.

Diagram of surgery

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:

  • Fever > 100.5 degrees F
  • Increased tenderness at the surgical site
  • Increased swelling or redness around the incision
  • Any unusual drainage or odor from the incision
  • Unexplained increase in pain
  • Nausea, vomiting, diarrhea, or constipation which is not improving

Who should I call with questions or concerns?

Office Hours: Monday-Friday 8am-5pm:
Office Phone: (734) 764-4151

After hours, weekends, or holidays for emergent issues only, call the hospital paging operator and ask for the pediatric surgeon on call at (734) 936-6267

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 office.

For pediatric appointments, please call 734.764.4151
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