1. Diagnosis of inguinal hernia (hernia) in children
The diagnosis is made by the presence of a reversible mass (lump) in the inguinal region or scrotum, together with a typical mass (lump) examined during a hospital visit.
Inguinal hernia in children is a protrusion of the pediatric intestinal canal or other organs from the inguinal canal through an unclosed sheath (congenital) and out of the body surface. It is more frequent in pediatric patients, more male than female, more right than left, and may be bilateral. It is usually detected shortly after birth, but also after 1 year of age.
Note: Repeatability means that the swelling can be returned into the abdominal cavity and disappear, and then reappear.
2. What are the effects of inguinal hernia in children?
(1) The hernia mass can be embedded or strangulated and life-threatening, and intestinal necrosis may require intestinal resection and intestinal anastomosis, and girls may have necrosis of the uterus, fallopian tubes and ovaries, affecting fertility; in addition, embedded hernia requires emergency surgery with long incision, oblique incision, bad appearance and high recurrence rate of hernia after surgery;
(2) Repeated return of the hernia mass or long-term compression of the spermatic cord affects the blood circulation of the spermatic cord and the development of the testes;
(3) The hernia mass increases in size with the prolongation of the disease, forming a scar and increasing the difficulty of surgery;
(4) As the intestinal canal repeatedly enters into the hernia sac, it affects the digestive function of the intestine, most children have poor digestive function and are thin, which has a certain impact on the growth and development of children.
3.What is the appropriate age for the child to have surgery?
Surgery is not recommended within 6 months of age; after 6 months of age, if the hernia attacks frequently, or even frequently gets embedded and goes to the hospital for manual repositioning, then early surgery is recommended; if the hernia attacks occasionally, then surgery can be done after 1 year of age, don’t delay too long and affect seeing on. Never believe the advice that it is better to do it when you are older and the child is obedient.
4.Can it be treated conservatively?
Conservative treatment is not possible! Do not use the two common methods in the society because of the fear of surgery.
(1) hernia belt therapy, using hernia belt long-term compression makes local muscle atrophy adhesion, hernia sac formation scar, bring difficulties to surgery, and affect the spermatic cord blood circulation, affect testicular development; some hernia belt plus Chinese medicine package is also meaningless.
(2) Injection therapy, absolutely undesirable. Injection of sclerosing agent can cause serious consequences such as testicular atrophy, cryptorchidism, intestinal adhesions and intestinal necrosis.
5.How to deal with hernia impaction?
Commonly speaking, an ingrown hernia means that the hernia is stuck and cannot be returned. If the stuck time is short, within 3-4 hours, and the general condition of the child is good, the child can be coaxed into a quiet position, lying down or head down to gently shake the child, or gently support the hernia back to the abdominal cavity, avoid violence! If the hernia cannot be returned to the abdomen, go to the hospital immediately for emergency treatment and try to reset the hernia manually. If the child is stuck for more than 12 hours or if the general condition of the child is not good, go to the hospital immediately for surgery, otherwise it is life threatening! I have been practicing medicine for more than 20 years and often encounter parents who do not know how long their child’s hernia has been stuck down. It is best to check every 1-2 hours if the child’s hernia has come down, and if it does, it can generally be returned to the abdominal cavity according to the above methods.
6.Surgical methods
(1) Improved traditional surgery: traditional adult surgery is an oblique incision in the inguinal region, about 3-5 cm long, which requires incision of the tendon membrane of the external oblique abdominal muscles and various repair methods, and now the patching method is mostly used. The incision is transverse inguinal incision, about 1cm long, without cutting the tendon membrane of the external oblique abdominal muscle, without patching, and the operation time is 10-15 minutes. Anesthesia is general general anesthesia.
(2) Laparoscopic surgery: 2 0.5 cm incisions are made through the umbilicus and abdomen, laparoscope and surgical instruments are placed, and the inner ring mouth is sutured. Anesthesia is general anesthesia with tracheal intubation, requiring muscle relaxant drugs and intraperitoneal injection of CO2 gas. The laparoscope is able to explore the contralateral side for the presence of a hernia and is slightly more expensive.
Choice of surgical method: Both of these methods have the advantages of less trauma, shorter operation time, faster recovery, less pain, shorter hospital stay and discharge the next day after surgery. As to which method to choose, the doctor will talk to the parents and they can ask for one of the methods, but of course, laparoscopic surgery is not usually chosen for incarcerated hernia.