Inguinal hernia (hernia for short) and syringomyelia (effusion for short) are one of the most common diseases in pediatric surgery, more common in boys. Many parents get entangled in the different statements of different hospitals and doctors before each clinic visit and surgery, so I would like to give some brief explanations about this disease. I. Are inguinal hernia and effusion congenital or acquired diseases? What is the difference between hernia and effusion? During the embryonic period there is a congenital channel between the abdomen and the groin, called the sphincter, which normally closes during the last 3 months of pregnancy. Pediatric inguinal hernias and syringomyelia are almost always the result of a congenital failure of the sphincter to close, but not all cases of non-closure of the sphincter will result in a hernia or effusion. Symptoms only arise when intra-abdominal organs or intra-abdominal fluid enters the sphincter. If it is an intra-abdominal organ (mainly the gut, omentum in boys and the ovary, gut or omentum in girls) that enters the sphincter, it is a hernia, and if it is intra-abdominal fluid that enters the sphincter, it is a fluid collection. A syringomyelia in girls is generally called a Nuck cyst or round ligament cyst. Generally, through symptoms and physical examination, the doctor can determine whether the mass is a hernia or a syringomyelia, but sometimes when the mass is only in the inguinal canal area or when there is both omentum, intestinal canal and fluid in the sphincter cavity, there is a bias in judgment, but it does not really affect the treatment, and the surgical approach is basically the same. Of course, it is recommended to routinely perform inguinal ultrasound examination before surgery, which will be more helpful for preoperative diagnosis. 2. Do hernias and effusions have to be operated? What is the best age for surgery? Inguinal hernia in infants can be detected as early as the first violent cry after birth, especially in premature babies. However, they are usually detected at 2-3 months of age or a little later. Does a hernia or effusion always require surgery? When is the best time to operate? Many parents are confused, and various hearsay stories add to their worries. Some people say that a hernia will get better on its own and no surgery is needed; some say that surgery is needed after the age of one and some say that it is needed at the age of three; however, we have heard that surgery should be done in a hurry and if surgery is not done in time, the intestines of so-and-so’s child will be necrotic or the testicles will be cut off, and there are cases where the child died because it was found too late. The current medical opinion is that inguinal hernia is very unlikely to heal on its own, and if more intra-abdominal organs enter the sheath due to a sudden increase in intra-abdominal pressure, there is indeed a risk of entrapment (jamming), which medically becomes an entrapment inguinal hernia (i.e., ingrown hernia), which, if left untreated, can be complicated by intestinal necrosis, testicular necrosis or ovarian necrosis, etc., and in more serious cases can lead to infectious shock In more serious cases, it can lead to infectious shock, which can lead to death, so the hernias need to be treated urgently. With the rapid improvement of surgical and anesthetic techniques, the risk of surgery and anesthesia for hernias and effusions is almost negligible, so inguinal hernias should be operated upon diagnosis, and the surgery is not limited by age. In particular, children who have had a history of impaction should be operated early. For syringomyelia, if the volume of the fluid is not large and the tension is not high, there is no urgency to operate, especially within 1 year of age, and there is a chance of self-resolution. However, for syringomyelia with high tension, it may affect the blood supply to the testes and lead to testicular atrophy, and surgery is not restricted by age. Third, what are the risks if I don’t have surgery? This sorry, parents you really have no choice but to have surgery. There is no medication for hernias and syringomyelia, including magical Chinese medicine, or hernia belts or whatever, and they have little effect. In the case of inguinal hernias, its main risk lies in the embedded inguinal hernia (ingrown hernia) described earlier. When an ingrown (commonly known as stuck) hernia occurs, come to the hospital as soon as possible and promptly for emergency treatment. Because the intra-abdominal organs enter the hernia sac and get stuck there and cannot be retracted, eventually there must be ischemia and necrosis, possibly intestinal necrosis or perforation, possibly testicular or ovarian necrosis, and eventually the necrotic intestinal tube or testicle or ovary has to be removed, and there are also testicular atrophy due to secondary testicular ischemia even though the testicle is not necrotic at that time. So, why take such a risk? The high skill of modern hernia surgery and the low risk of anesthesia are no longer comparable to the past. As for syringomyelia, it can compress the spermatic cord and testicles, affect the blood supply to the testicles, or increase the temperature of the environment in which the testicles are located, all of which are detrimental to testicular development. Fourth, laparoscopic surgery or open surgery is better? This is a question that almost all parents struggle with before surgery. It can be said that both laparoscopic surgery and open surgery are very mature and clinically proven surgical methods with very good results, and the recurrence rate is less than 1%. Each of the two surgical methods has its own benefits. V. Is inguinal hernia or syringomyelia surgery safe? It is very safe and accidents are very rare. The main complications of surgery are: damage to the vas deferens or spermatic vessels, wound infection, medically induced cryptorchidism (the testicle is in the scrotum before surgery but stays in the groin after surgery), and recurrence after surgery. However, the incidence is very, very low. VI. Why did my child have a hernia (effusion) on one side and after some time, the opposite side reappeared? The recurrence rate after inguinal hernia and syringomyelia is less than 1%, and for a large children’s specialty hospital like ours, the recurrence rate is even lower. As for having a hernia (effusion) surgery on one side and after some time a hernia or effusion appears on the other side, it is not a recurrence, but a new hernia. The etiology is still the same as previously talked about, both sphincters of the child were not closed before surgery, only one side was symptomatic and the other was asymptomatic. The surgery, if done with a high sphincter ligation on one side and not on the other, naturally the one without surgery may have the same hernia or effusion this time. If you choose laparoscopic surgery, you can see whether the sphincter is closed on both sides at the same time, and if not, you can suture the inner ring opening on both sides at the same time to effectively reduce such a situation. VII. Precautions before and after syringomyelia and hernia surgery Inguinal hernia and syringomyelia are elective surgeries, and it is safer to choose a time when the child is in relatively good health, for example, after diarrhea and upper respiratory tract infection have healed. Emergency surgery is needed for children who have failed to reposition an incarcerated hernia by manipulation or who cannot be repositioned by manipulation. The inguinal hernia and syringomyelia can be discharged the same day or on the second day after surgery. There may be slight pain after surgery, but it does not affect the child’s life or school. The incision will be covered with a sterile dressing after surgery, and the excipient is usually changed once in 3 days after surgery, and it is required to keep the incision clean and dry, and to change the dressing in time if it is stained. You can take a shower 2 weeks after surgery, and there is no need to use antibiotics after surgery. Try to avoid strenuous activities for 1~3 months after surgery, but of course daily activities need not be restricted.