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.
YOUTUBE PLAYLIST: This list on Inguinal Hernias contains 14 short videos. Press the forward and backwards control to move between videos.
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.
IMPORTANT: Inguinal hernias, will not disappear by themselves.
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:
- Incarceration: where the hernia is stuck, causing bowel obstruction. The abdomen becomes distended and the child will start to vomit, often bile ( green)
- Strangulation of the hernia: where the blood supply to the herniated intestine is cut off and become necrotic after which it perforates.
- 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 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 Treatment for children – surgery is always needed
When it comes to treating pediatric inguinal hernias, prompt surgical intervention is typically the recommended approach. The goal is to prevent complications like incarceration or strangulation of the hernia, which can occur if a portion of the intestine becomes trapped and its blood supply is cut off.
The condition usually necessitates surgical intervention, with two types of surgeries commonly performed: open surgery and minimally invasive laparoscopic surgery (keyhole surgery).
The Limitations of Traditional Open Surgery
In contrast to laparoscopic surgery, the traditional open method for treating inguinal hernias in children presents a few significant disadvantages.
Large Incision Size & Scaring: Traditional open surgery for inguinal hernias necessitates a sizable incision in the groin area to access the hernia. This cut may need to be even larger in older or larger children to ensure adequate access. Not only does this result in more extensive scarring post-surgery, but it also increases the potential for wound complications and discomfort during the healing process.
Limited Accessibility: One of the principal drawbacks of open surgery is its limited range of access. To repair a hernia, the surgeon must cut through the skin, fatty tissue, and muscle layers, which restricts their ability to visualize and explore the entire inguinal region. Conversely, laparoscopic surgery, with its camera-guided instruments, allows for comprehensive access and the opportunity to examine the contra-lateral side, potentially identifying any additional hernias that may be developing.
More Trauma & Longer Recovery Times: Because open surgery involves cutting through multiple layers—skin, fat, and muscle—to reach the hernia, it is considered more traumatic than the laparoscopic approach. This increased tissue trauma often translates into longer recovery times, more post-operative pain, and a delayed return to normal activities for the child.
The Advantages of Keyhole Surgery for Paediatric Inguinal Hernia
For over two decades, keyhole surgery, also known as laparoscopic surgery, has been the method of choice for performing inguinal hernia surgeries in both adults and children.
The reasons for this are clear when considering the procedure itself and the associated recovery times.
Less Invasive: As the incisions are significantly smaller, the procedure is less invasive, leading to quicker recovery and less postoperative pain.
Reduced Scarring: Due to the minimalistic incisions, scarring is significantly reduced compared to open surgery.
Ability to Check the Other Side: One major advantage is the ability to use the camera to inspect the opposite side of the hernia. This allows the surgeon to identify any developing hernias and repair them during the same procedure, preventing a potential second surgery.
Identification of Internal Issues: The keyhole method also provides the opportunity to check for any internal injuries or abnormaliti
Inguinal Minimally Invasive Laparoscopic Surgery Process
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.
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.
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.
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.
The story of my 6 year old patient and his case of Inguinal Hernia
Allow me to share with you a real-life scenario that showcases the effectiveness of laparoscopic surgery in treating pediatric inguinal hernia. The case involves a six-year-old child who came to me with a hernia on his left side. This was a particularly interesting case because the child had undergone a hernia repair on his right side just a year before.
His parents were naturally concerned about the recurrence of the hernia and wondered why it was happening again. They were also worried about the potential for another hernia on the opposite side in the future. To address this, I decided to employ the laparoscopic technique.
During the surgery, I inserted a camera into the child’s abdomen. This allowed me to get a clear view of the hernia, which I was able to repair effectively. One of the great advantages of laparoscopic surgery is the ability to examine the other side of the abdomen. So, after repairing the hernia on the left side, I swung the camera over to the right side, where the previous surgery had been done, to check for any signs of a new hernia.
This examination gave us the good news that there was no hernia developing on the right side. This ability to check both sides during a single operation is a distinct benefit of laparoscopic surgery and helps prevent the need for additional surgeries. Not only was I able to reassure myself of the effectiveness of our treatment, but I could also provide the parents with the peace of mind they were seeking.
This case highlights the unique benefits of laparoscopic surgery for pediatric inguinal hernia. With this technique, we can check for hernias on both sides, repair them if present, and limit the risk of future surgeries. Additionally, the minimally invasive nature of laparoscopic surgery results in less post-operative pain, quicker recovery, and minimal scarring, enhancing the quality of life for our young patients undergoing hernia repair.
Dr Nada’s shares a story about his patient
Patient Testimonials
As our little Isabelle celebrates her first birthday, we wanted to take a moment to express our deepest gratitude for the incredible care you’ve provided.
We are especially grateful for your skillful work in performing Isabelle’s hernia laparosscopic surgery. The thought of our baby undergoing surgery was daunting, but your expertise and the successful outcome have given us such immense relief and joy. Thank you for ensuring her well-being and for your precision and care during that crucial time.
It’s hard to believe a year has already passed, and we’re so grateful to have had you as such vital parts of Isabelle’s journey. Thank you for everything you do.
Lyndesa & Melvin – parents
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.
