Pediatric inguinal hernias (inguinal hernia) are all hiatal hernias and are almost always congenitally unclosed sheaths characterized by the posterior wall of the hernia sac abutting the spermatic cord. Not all open sheaths will develop inguinal hernias. Statistically, 57% of infants under 1 year of age are found to have an unclosed syringomyelia at autopsy, while the number of those with clinical manifestations of hernia is much lower. A hernia is formed only when an abdominal organ is pushed into the unclosed syrinx. Increased intra-abdominal pressure is a predisposing factor for hernia, such as severe crying, prolonged coughing, constipation and dysuria. In addition, the pediatric inguinal canal is very short, about 1 cm, and leads nearly vertically from the inner ring to the outer ring. When the abdominal pressure increases, the pressure is directed directly to the subcutaneous, without the cushioning constraints of the oblique inguinal canal. Infants also lie on their backs, and the two hips are often flexed, externally rotated, and adducted, which makes the abdominal muscles flaccid, and the contraction force is weakened, so that hernia can easily occur in infancy. Clinical manifestations Inguinal hernia in infants can appear in the first violent cry after birth, especially in preterm infants, because their sheath protrusions have not been completely occluded, the incidence of hernia is higher. However, they are usually found at 2-3 months of age or a little later. The mass protrudes from the outer ring only when crying or straining, and disappears if fed or quieted. In inguinal hernia in toddlers or older children, with the increase in the number of episodes, the bulging mass stretches towards the upper pole of the scrotum and increases in size, in some cases the mass enters the scrotum or even the base of the scrotum, and stays outside the abdominal cavity for a longer period of time, and disappears when the mass lies down. Inguinal hernia without complications is usually painless except for swelling. Growth and development are also no different from normal pediatrics. Local inguinal examination shows that smaller inguinal hernias are located in the outer ring and the beginning of the scrotum and are oval in shape. Larger ones may descend into the scrotum and have a heart-shaped appearance. The mass is soft, elastic, and the upper pole fades into the inguinal canal at the outer ring with indistinct borders. By gently pressing the mass upward with the hand, the mass can be returned to the abdominal cavity and a gurgling sound can be heard. After repositioning, a finger is pressed against the inner ring, and the impulse can be felt when the pediatrician coughs. Remove the finger and the mass reappears. In many cases, no mass is present at the time of presentation, and the hernia is still not seen after increasing the abdominal pressure. A careful comparison of both sides of the inguinal region should be made, and sometimes a slight bulge can be found on the side with the hernia. Sliding a finger back and forth over the inguinal ligament may reveal a thickened spermatic cord and the sensation of two layers of silk rubbing against each other. Treatment Although the peritoneal sheath can remain occluded after birth, children with hernias rarely heal spontaneously. Therefore, inguinal hernias should always be treated surgically after diagnosis to prevent multiple occurrences of pincer-occluded hernias, even in premature infants. Surgical treatment of inguinal hernia is safe and can be performed regardless of age. However, since it is an elective surgery, it is better to choose the appropriate time. Frail and sickly children prone to upper respiratory tract infections, long-term cough prompted by the frequent appearance of hernia, parents often more urgent mood for treatment, at this time the parents should be persuaded, the first treatment of the original disease, in the appropriate season for surgical treatment. Children with serious diseases, such as cyanosis congenital heart disease, malnutrition and infectious diseases, such as general weakness should be postponed surgery.