Pediatric hernia, is one of the most common surgical conditions in children. There are two usual causes of hernias, one is a congenital developmental defect and the other is caused by an acquired cause. When a hernia occurs in infancy, it is usually caused by a congenital developmental defect. Congenital developmental defects refer to defects in the development of the inguinal structures, because the inguinal canal, which constitutes the hernia channel, is composed of three parts: the internal opening, the external opening and the channel.
Under normal circumstances, the inguinal canal, which is directly connected to the abdominal cavity, should be closed at birth, but in some infants, the residual peritoneum (called the sphincter), which originally wrapped the descending testes, is delayed or not closed at the inguinal canal at birth, leaving this channel open.
When the baby croaks, along with the first cry and later crying or all activities that cause an increase in abdominal pressure, the organs in the abdominal cavity, such as the small intestine, colon and appendix, can be sickened out from the inner mouth through the outer mouth of the inguinal canal and fall into the scrotum, thus forming what is known as a hernia. Generally speaking, hernias are more common in boys than in girls.
The most common type of pediatric hernia is an inguinal hernia, where the abdominal pressure increases when crying and the abdominal organs, mainly the intestinal canal (possibly the uterus or ovaries in girls), protrude from the unhealed area and, if not retrieved, can easily cause intestinal obstruction with intestinal distention, non-exhaustion, non-defecation and vomiting, which can be life-threatening if not treated in time. Once a hernia is formed, it does not or rarely has the possibility of disappearing on its own.
A. The following possibilities may occur.
1. The occurrence of impaction of the hernia contents is called an incarcerated hernia.
It is one of the most painful and harmful complications for the affected child. Of course, not every child with a hernia has to have an incarcerated hernia. The occurrence of incarcerated pain is usually caused by two factors.
The first one is that the internal opening of the hernia is so small that the herniated intestine cannot be returned by itself; the second one is that the herniated contents are so large that they stay too long in the bursa, squeezing each other and causing edema in the tissues, so that the intestine cannot be returned to the abdominal cavity, or the herniated intestine has abnormal changes in the feces, which can cause intussusception. In women, hernias are often caused by ovarian adnexal disease, and after herniation of the ovary, impaction is most likely to occur. Once the herniated tissue becomes embedded, there is a possibility of intestinal necrosis and perforation, and subsequently, the child will have a series of intestinal obstruction lesions such as abdominal pain, vomiting and fever.
2. “Small hernia” becomes “large hernia”.
At the beginning, the hernia is small because the hernia opening is small and the contents of the hernia are small. However, over time, the hernia opening of some children will gradually become larger and the tissue that comes out of the disease will gradually increase, so the “small pain” will become a “large hernia”. Although hernia is a localized disease, its regression is very much related to the general health condition.
For example, in a malnourished and calcium-deficient child, the muscles and ligaments in the groin are lax and weak due to the “thin” muscles of the whole body, so the contents of the hernia encounter little resistance through the inner opening, and the inner opening expands, and the hernia pouch also expands, forming the so-called “large hernia The hernia pouch also expands, which forms the so-called “large hernia”. Therefore, we should pay attention to the nutritional supplement of diet and the prevention and treatment of various infectious diseases of the lungs, such as cough, which are also essential for the treatment of Shanqi.
Usually, those small children who have less chance of herniation out are extremely easy to be embedded once the hernia contents come out because the inner opening of the hernia is relatively small. For the care of such small hernias, attention should be paid to the timely return of the contents of the hernia, so that the hernia does not protrude for too long. When squeezing, the child should be made to lie down to reduce abdominal pressure, and in a relatively quiet situation, parents should use the five fingers of the right hand to squeeze the hernia sac (in the scrotum) upward continuously at the same time for about 3 to 5 min, and most of the hernia contents will be squeezed into the abdominal cavity.
When the parents repeatedly squeeze, the painful sac does not shrink and the child is restless due to the hernia pain, the child should go to the hospital in time for the doctor to deal with it to avoid the occurrence of incarcerated hernia. For those hernias that are already free to enter and exit, there is no need to rush to squeeze and return them. Many parents think that hernias are trivial and always want to wait until their children are older, and some parents think that surgery with general anesthesia will make their children stupid, so they do not want to let their children have surgery.
Some advertisements cater to this psychology of parents, saying that wearing hernia belt and injection therapy can save the pain of surgery, but these methods cannot cure the hernia at the root. The only way out to cure hernia and stop the occurrence of incarcerated hernia is to treat it with surgery.
II. How to operate for pediatric hernia?
1. Elective surgery.
According to the anatomical characteristics of pediatric groin, it is appropriate to choose surgery for pediatric hernia around the age of 1 year because the groin in the neonatal period is very short (about lcm), the muscles are thin and most of the muscles there are not well developed, therefore, premature surgical treatment will make the hernia easy to recur; as the child grows older, after the 8th month of age, the muscles in the groin and lower abdomen have thickened and the inguinal canal has become longer, therefore After the 8th month, pediatric hernia can be the starting point for elective surgery, which is the reason why doctors often choose to perform the surgery around the age of 1 year. Moreover, surgery at this age results in faster wound healing and smaller scars after surgery, and it is easy to care for children around 1 year old after surgery, so some people call around 1 year old the “golden age” for this surgery.
2.Emergency surgery.
When a pediatric hernia becomes incarcerated and fails to be returned by extrusion, emergency surgery should be considered the correct indication. However, many new pediatric surgeons do not advocate emergency surgery for pediatric ingrown hernia. Therefore, surgery is appropriate only when repeatedly failed to restore the hernia, or when the hernia has been embedded for too long.
3. There should be no complications of other infectious diseases before surgery.
Before receiving the surgery, diseases such as cold, bronchitis and pneumonia should not occur. If the child is found to be crying, the child’s pants should be peeled open to see if a bulge is found, and the child should be promptly examined at a regular hospital. To avoid complications of hernia, early surgery should be performed once the diagnosis is confirmed.