What causes hernia in children and why is the incidence higher in boys than in girls?
A hernia is a protrusion of a tissue or organ of the body from a weak part.
In early embryonic life, the testis is located behind the peritoneum next to the 2nd to 3rd lumbar vertebrae and then gradually descends outside the abdominal cavity. The descending peritoneum forms a sheath, which atrophies and atresizes shortly after birth, leaving a fibrous cord behind. If not atretic, a congenital hiatal hernia may be formed. Sometimes, the unclosed sphincter is just a very small duct, which does not appear clinically as a hernia, but only as a syringomyelia.
The right testis descends slightly later than the left and the sphincter atresizes later; therefore, right inguinal hernias are more common.
Girls have a round ligament of the uterus that descends from the same site outside the pelvis and also forms a peritoneal sphincter, so girls also have hernias. Girls do not have the process of downward migration of the testicles and the sphincter closes early, so the incidence is lower in girls than in boys!
How can I tell if my child has a hernia?
Generally, a hernia or syringomyelia should be considered when a child has a mass in the groin area.
Can a hernia heal itself? What should parents do while waiting for surgery?
The sphincter can close for a period of time after birth, but once a hernia is formed, it is rarely likely to heal on its own. There is no need to wait for a hernia to heal on its own after it is diagnosed. You should seek the advice of a pediatric surgeon who specializes in pediatric surgery. Many lay doctors tell you that it will heal on its own within the age of half a year because their knowledge is not up to date, which is an incorrect opinion! Surgery after one year of age is even more wrong! While waiting for the surgery to take place, it is important to closely observe if there is an incarcerated hernia!
Can parents detect an incarcerated hernia? What should parents do if an incarcerated hernia occurs?
If your child’s hernia mass does not go away for several hours even after he/she is quiet or sleepy, and if he/she cries a lot or even vomits, you should pay attention to whether the hernia is ingrown. In this case, you should go to the hospital immediately, and you can adopt an elevated hip position on the way, and it is not recommended to reset the hernia by yourself. Be aware that vomiting may lead to aspiration!
When does a child need surgery?
Pediatric hernias should be operated on as soon as they are diagnosed to avoid incarceration. There is no age limit for surgery and I personally recommend that any hernia in the first three months of life should be treated in the hospital as soon as possible!
What is the current surgical approach? How many days of hospitalization are needed?
Currently there are two types of surgery, traditional or minimally invasive laparoscopic surgery, with a hospital stay of 1-3 nights.
Traditional high ligation of the hernia sac is the basic treatment for pediatric inguinal hernia, but the surgery disrupts the anatomy of the inguinal canal and spermatic cord. There is about 10% incidence of scrotal hematoma, and about 0.5-1% of male children are damaged vas deferens or epididymis intraoperatively, and postoperative complications such as testicular atrophy may occur. It is already being phased out!
Minimally invasive laparoscopic hernia surgery directly observes the hernia contents without dissecting the inguinal canal and without separating the spermatic cord tissue, thus avoiding the complications of traditional surgery mentioned above. The laparoscope allows intraoperative observation of the closure of the contralateral sphincter (current statistics show that about 30-40% of children have a combination of non-closure of the contralateral sphincter), eliminating the possibility of a contralateral hernia in one operation without increasing the surgical incision. The laparoscopic incision is made in the umbilicus without sutures, and experienced surgeons can achieve an incision scar almost completely hidden in the umbilical fossa.
Will surgery in boys affect future fertility problems?
The normal surgery by a highly trained specialist will not affect the future fertility of the child!
Is there any significant post-operative pain?
All surgeries are painful, but the pain after minimally invasive surgery is very minimal. A small number of children are sensitive and can have post-operative analgesia.
Will there be recurrences after surgery?
All hernia surgeries have the possibility of recurrence, but the rate of recurrence varies between hospitals and doctors of different skill levels. The recurrence rate after laparoscopic surgery in children’s specialty hospitals is usually within 1 in 1000! This is a very good result!
What are the things to pay attention to after hernia surgery?
For a period of time after hernia surgery, you should try to avoid strenuous activities such as lifting heavy things, carrying heavy objects, coughing and sneezing. Young children should try to minimize crying.