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Inguinal Hernias in children – everything parents in Malaysia should know

Dr. Nada Sudhakaran
Paediatric Surgeon & Urologist

Inguinal Hernias in children – everything parents in Malaysia should know about them

What are Inguinal Hernias in children?

Hernias happen when any structure from within a body cavity goes through an opening and ends up in an abnormal position. In the case of inguinal hernias in children, it’s usually intestine from inside the tummy that goes through the opening in the muscle and is found within a sac (encasement) in the groin. These usually appears as a lump in the groin of your child, that may come and go. This is because the intestine can slide in and out through its muscular opening easily.

Inguinal hernias occur in about 3% children and 95% of these are in boys and 5% in girls. It can happen at any age from birth, especially in premature infants. Children under 1 year of age tend to have more symptoms and have higher risks of complications.

Inguinal Hernia Symptoms in children

Parents first notice a lump in the groin of their child (see diagram above) This lump comes and goes and usually appear when your child is crying or straining. Most children with an inguinal hernia will experience some  discomfort or pain. This is possibly why babies with an inguinal hernia tend to be more unsettled and fussy.

When the intestine protrudes through the muscle, there is some constriction on the intestine causing some air trapping within the protruded intestine and also blocking the flow of gas and intestinal content upstream. This is the cause of colicky pain kids with hernia experience, especially in babies. If the intestine is stuck for 4-6 hours, there will be swelling of the muscle layer which further constricts and strangulate the intestine and eventually cut off the blood supply to the protruded intestine. This will make the hernia area very painful and the swelling red and swollen. At this stage it has become a surgical emergency needing urgent assessment by a paediatric surgeon.  

The hernia lump may not always be present so it’s helpful if parents to took photos of the lump on their mobile phone when it’s obvious. This is to confirm its presence and to confirm the correct side. We sometimes rely on history alone to perform the surgery so the photo would be useful.

A painful groin swelling that is not going back on gentle massaging, associated with vomiting and constipation is an emergency and the child must be assessed by a paediatric surgeon.

Inguinal hernias, will not disappear by themself.

Massaging the hernia may return its content (intestine) back into the tummy but the opening will still remain and the hernia will reappear. Vigorous massaging can also cause damage to the blood vessels to the child’s testicles and hence the testis to shrink.

Why Inguinal Hernias need urgent intervention in young children

The reason inguinal hernias need to be fixed in children is because they can cause complications, such as:

  1. Incarceration: where the hernia is stuck, causing bowel obstruction. The abdomen becomes distended and the child will start to vomit, often bile ( green)
  2. Strangulation of the hernia: where the blood supply to the herniated intestine is cut off and become necrotic after which it perforates.
  3. The hernia may compress on the blood vessels to the testis at the inguinal ring and cause testicular loss in boys.

These risks are higher in children under 1 and especially within the first month of life.

Inguinal Hernia Treatment for children

Inguinal Hernias must be corrected as soon as possible, especially in the under 1 yr old. When the hernia is stuck (incarcerated) and in case of strangulated hernia they will need urgent reduction or emergency surgery.

Inguinal Hernia
Diagrams showing how the intestine enters the opening in the muscle. (figure a to c). Figure d shows the intestine has returned back into the tummy but the opening remains

Treatment of inguinal hernias is surgical. There are no role of any conservative treatment or bandage (truss) to contain the hernia. In kids they are repaired urgently to prevent the above mentioned complications.

Inguinal Hernia Surgery for children

Surgery is conducted under general anesthesia. One parent is allowed to accompany your child into the anesthetic room until your child falls asleep. The anesthetist will take 20 minutes for their procedures before surgery commences.

Like most premier children surgical centers in the world, my choice of repair is to perform it laparoscopically (keyhole surgery).

Laparoscopy allows for the contralateral (opposite) side to be examined and repaired at the same time if present (see pictures below). You will already know that keyhole surgery is less traumatic and stressful for your child. For a single side hernia repair, it takes 20 to 30 minutes to perform and for both sides, up to 45 minutes in total.

Surgery is done as day procedure and recovery is amazingly quick.

Laparoscopic view of the “hole”: right sided inguinal hernia repair in a 2 months old boy
Laparoscopic view of the “other side”: Photo on left: no obvious “opening”; picture on right, when probed: an opening that will lead on to a formation of hernia. This was be repaired to avoid a hernia here and a second operation later.
Hernia repair in girls: important to check for the female organs; in oval: the uterus and arrows: the ovaries

Inguinal Hernia Recovery for children

After surgery, your child will be allowed some fluid to drink and return to normal diet as tolerated. There will be local anesthesia applied to the wound sites hence your child should be pain free for 4- 6 hours, after which, simple analgesia provided should be given regularly for 2 days at home. Most children will be able to return home 3 to 4 hours after surgery.

Wounds following laparoscopic hernia repair closed with “skin glue”

At home they can do most activities provided the wounds are not painful. They can shower but not soak in a bath for 4 days as soaking will “peel off” the glue on the wounds. (The wounds takes about 4 days to heal and become “water-tight”). There is very little in the way of care of the wounds as they well covered by the glue. Your child will be seen in clinic a week after the procedure, to check on the wounds.

Patient Testimonials

After having the key hole surgery, I could not believe how much improvement on my little baby boy. The result was almost instant. Following the operation, he had very little pain, just mild discomfort only. He was discharged from the hospital, on the same day of his operation. Small surgery scars were found and almost can’t be seen on his stomach. Now my little baby boy is doing well.

Shanti Raj Sue Yin – mother

“Thank you! Dr. Nada.” This is my wholehearted gratitude.

We rarely see the examples of newborn baby girl with inguinal hernia. Unfortunately, my two-months-old daughter is one of them.

On 24 of November 2014, I was surprised to discover the protrusion of my baby right groin after she cried. In the next morning, I contacted you via email and I was glad to receive your immediate response, and able to make an appointment with you to take a look on my daughter at hospital on the same afternoon.

From your professional analysis, my husband and I have a better understanding on the etiology and treatment of inguinal hernia. While we are aware that inguinal hernia cannot recover by self-healing and it is potentially to incarcerate at any time, which will cause organ necrosis and life-threatening. Thus, we have decided to let our baby underwent the laparoscopic surgery.

Waiting is always suffer. Fortunately, you able to schedule the operation for my daughter on 28 of November 2014 from your tight schedule. Within 2 weeks, my baby was recovered and her returned smiles is the best happiness and satisfaction to us.

Lastly, thanks for the recommendation from the feature writer, Mr. Ong Eng Leong, of Long Life Magazine. With that, my daughter was lucky to meet such a professional and caring doctor like you.”

Yvonne Teh, mother

Originally published in Easily Sin Chew on 25-04-2019
in Mandarin. Click HERE.

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amelia

hi dr. thanks for the write up. actually im one of the patient who have this. i went surgery when i was 2. now my age is 23. im female. but i think, this have the side effect when growing up. i easily have bloated stomach and difficult to have normal daily poo. means that, normal people usually poo everyday, but not me, i only can poo about twice a week or once a week only even though i drink plain water a lot and eat veggies and fruit everyday. but still it cant help. is it normal to me… Read more »

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Dr Nada Sudhakaran

Paediatric Surgeon & Urologist

Paediatric Surgeon

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02 Dec 2020, 17:42

Dr Nada Child Surgeon

When it comes to Appendicitis in children, usually the only solution is to remove the appendix via surgery (appendectomy).

Parents will have two types of surgery to choose from:

1) OPEN surgery, or

2) KEYHOLE surgery (or laparoscopic surgery).

Do you know what the difference is between these two techniques?

One of them leads to less scarring, less pain and faster recovery for the child.

Find out which one that is by watching Dr Nada's video below

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Also you can find out all about Appendicitis in children and how it can be treated in Malaysia by reading this helpful article:

www.drnadachildsurgeon.com/resources/appendicitis-in-children-what-is-it-and-how-it-can-be-treate...

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Dr. Nada Sudhakaran, is a paediatric surgeon & urologist specialising in Keyhole Surgery – a procedure that helps your child experience less pain, recover faster & gives you peace of mind.

He is based in Kuala Lumpur, Malaysia.

#appendicitis #surgery #pediatrics #paediatrics
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