Hernias can be quite common in children and adolescents. A hernia is the bulging of an organ or tissue through an abnormal opening. Hernias are caused by a disruption or opening in the fascia, or fibrous tissue, which forms the abdominal wall. It is possible for the bulge associated with a hernia to come and go, but the defect in the tissue will persist.
The experts at Pediatric Surgeons of Phoenix are specially trained at the surgical correction of epigastric hernias, hiatal hernias, inguinal hernias, hydroceles, and umbilical hernias in children and adolescents. General information about hernias is below. For more information on specific conditions, diagnoses, and treatments, please use the links on your right.
What is a Hernia?
During fetal life, the testes develop in the abdomen near the kidney. They gradually descend through an opening (called the “inguinal canal”) into the scrotum. During this descent, the testes take with them a pouch of the thick, cellophane-like membrane that lines the abdominal wall (peritoneum). If this lining persists, intestines can descend down into the inguinal canal or scrotum. This opening is called a hernia. The visible lump or swelling in the groin or scrotum is a loop of intestine that is passing through the open canal. If only abdominal fluid comes down, this is called a hydrocele.
Although girls don’t have a testicle, they also have an inguinal canal. The round ligament comes from the uterus through the inguinal canal. Girls do get hernias and may have intestine or an ovary come through the canal into the groin area. The surgical repair is almost the same as for boys.
Incarceration
Inguinal hernias require repair because intestine may become trapped in the inguinal canal. This is call an incarcerated hernia. Incarceration can result in loss of blood supply to the intestines, testicles, or ovary. If this happens, the hernia will become painful, sore and hard. Normally, hernias are soft and squishy and do not cause pain. If the hernia becomes incarcerated, the doctor will need to see the child in the emergency room and reduce the hernia. If the hernia can be reduced, surgery is scheduled within a few days. If not, surgery will be done right away.
Surgery
To repair a hernia, an operation is performed as an outpatient (same-day surgery) under general anesthesia. After the child is asleep, an I.V. will be started by the anesthesiologist to give fluids and medications during the surgery. A horizontal incision is made over the inguinal area in the crease of the low abdomen. The lining (or hernia “sac”) is located, freed off the vas or round ligament and the opening into the abdomen closed. The incision is covered with a piece of paper tape. After surgery, you can expect some swelling and, perhaps, bruising of the scrotum.
Recovery
After surgery, the child is taken to the recovery room. Generally, you will be able to be with your child as soon as he or she is awake. During this time, the effect of the anesthesia gradually wears off. At first, the child may be dizzy and have difficulty focusing. He may have spells of restlessness and excitement and sleep on and off. Your child may be nauseated from the anesthesia. He or she will be given small amounts of clear fluids. Infants may be breast-fed. If the child has no problems with nausea or vomiting, a normal, light diet may be resumed shortly after surgery.
Post-Op Care
It is not unusual for the child to run a temperature after surgery. Tylenol as directed for age will help reduce the fever and take care of any minor discomforts. You may be surprised at how rapidly your child recovers from his operation. Generally, he is only sore and tired for a day or two. The child may resume normal activities, without fear of harming anything. Exceptions include no straddling toys, such as bicycles or hobbyhorses, for one week as this will increase the tendency for swelling. The dressing needs to remain on and dry for three days for infants and one week for older children. You will need to wash around the area and change the diapers frequently so that the wet diaper doesn’t soak against the tape and promote wound infection. The doctor will want to see the child back in the office the following week. Please call the office to make an appointment.
Possible Complications
All complications from inguinal herniorrhaphy are rare. Possible complications include those listed below.
- Anesthetic complications.
- Recurrent hernia. Recurrent hernias occur in less than 1% of cases. Patients with certain other diseases have an increased risk of recurrent hernia; the diseases include hydrocephalus, liver disease with ascites and connective tissue disorders.
- Injury to testis. The artery or vein to the testicle can be injured, resulting in failure of the testicle to grow in the future. This is very rare. Hernias that have been incarcerated sometimes cause testicle atrophy (diminished size).
- Injury to vas. The vas, which carries the sperm from the testicle, can be injured. This rare complication can cause lack of sperm production from the testicle.
- Wound Infection. Wound infections, while rare, are the most common complications.
- If you have any questions or concerns at all, please do not hesitate to call the office at 602-254-5561.