”The baby’s small intestinal gas will fall out accidentally, and we are very worried about the impaction. But I heard that anesthesia can affect intelligence, what should I do?” This is one of the many inquiries from parents of children with hernia. When is the best time to operate on a baby with small bowel gas? Here I will talk more about how to choose the timing for pediatric inguinal hernia surgery. 1. Hazards of inguinal hernia The occurrence of pediatric inguinal hernia is closely related to the development of the reproductive system, and some affected children are accompanied by deformities of the reproductive system. The presence of a hernia can affect the baby’s digestive system and genitourinary system. The repeated protrusion of the hernia can affect the baby’s daily life and movement, thus affecting growth and development. 2. Risk of acute ingrown hernia The ingrown hernia can cause intestinal obstruction, intestinal ischemic necrosis and peritonitis, which are the greatest hazards of hernia. The difficulty of surgery and the operation time of an incarcerated hernia are significantly increased. In addition, pediatric ingrown hernia often requires sedation or anesthetic medication during manual retraction, which may also have adverse effects. 3. abdominal wall development and inguinal hernias Pediatric inguinal hernias are mainly due to unatretched sphincters. In children, the abdominal wall is weak, the inguinal canal is short and straight, and there is no true defect. As the abdominal wall develops and the muscles grow, the inguinal canal becomes longer and the obliquity increases. The presence of a hernia will impede the development of the inguinal region, causing a true abdominal wall defect and causing a hernia in adults. One study found an increased recurrence rate after surgery in children older than 6 years of age. 4. Pediatric inguinal hernia surgical approach Because the abdominal wall defect does not exist in pediatric patients, inguinal hernia surgery is performed only by high ligation of the hernia sac without abdominal wall repair, much less patching. The average operating time for a skilled specialist is about 10-15 minutes and rarely exceeds half an hour. 5. Effects of anesthesia on children A joint statement from the U.S. Food and Drug Administration and the American Academy of Pediatrics and other agencies: The effects of anesthesia and sedative drugs on children are inconclusive at this time. If a child undergoes a procedure that lasts less than 2 hours, there is no risk. The fact is that the mechanism by which anesthetic drugs put people under anesthesia is not yet medically clear. But as with any drug there are possible adverse effects that can be avoided if possible. 6. Observation and emergency care for hernias Pediatric inguinal hernias require close observation to try to keep the hernia from bulging out so as to minimize the impact on daily activities and growth and development, although in practice this is difficult. Once ingrown, self retraction is dangerous and difficult and requires emergency management at a nearby hospital. I recommend early surgery if the baby’s hernia is repeatedly protruding and incarcerated, or if the parents are not in a position to observe it closely, or if the nearby hospital is not equipped to treat pediatric hernia in an emergency setting. If the hernia rarely protrudes, the parents are able to observe the baby closely and are very concerned about anesthesia, and the nearby hospital is equipped for emergency pediatric hernia treatment, then the surgery can be performed under close observation at a later date. If a deadline must be given, then 4 years of age or older, up to 6 years of age, or 5 years of age should be the least worrisome period for surgery. Finally, I would like to remind parents that inguinal hernias in babies older than 6 months of age hardly ever heal on their own anymore, and only surgery to cure the hernia can really avoid the associated risks!