What a cute kid! It hurts to have to operate when you have small intestinal gas! Is there a minimally invasive way? Of course there is, and today we will talk about minimally invasive laparoscopic surgery for the pediatric groin. Our cute little babies are actually the most prevalent group of hernias, accounting for about half of the total number of hernias, especially in premature and low birth weight babies. Pediatric hernias are mainly inguinal and umbilical hernias, with the former being the most common. Pediatric hernia surgery is also the most commonly performed procedure in pediatric surgery after circumcision. The vast majority of pediatric inguinal hernias are congenital. The underlying cause is a structure called the sphincter that does not close properly during growth and development, which means that a small hole is left in the inguinal region at the junction of the thighs and lower abdomen, through which the small intestine in the abdominal cavity can escape and reach the skin below. Both boys and girls can have inguinal hernia, but boys are much more likely than girls to have inguinal hernia because of the process of the testicles descending into the scrotum, with a ratio of about 15:1. The typical clinical presentation is a lump that appears sometimes next to the “penis”, which appears and increases when the child cries and moves around, and decreases or even disappears when the child lies down or falls asleep. After lying down and sleeping, the lump decreases or even disappears completely. The diagnosis can be made through routine physical examination and ultrasound. The symptoms are significant because repeated protrusion of the intestinal canal can cause gastrointestinal symptoms such as abdominal distension and pain, and in severe cases, acute complications such as intussusception can be life-threatening; in addition, boys may also affect the development of the testicles. Before the age of 1 year, a small number of children with milder conditions may heal spontaneously, but those with larger hernias or those that have not healed spontaneously beyond the age of 1 year require surgery. The surgery for pediatric hernia is simpler than for adults, as the hernia sac can be ligated at a high level, unlike adults who need to be reinforced with a patch. The principle of surgery is very simple. To put it plainly, it is to find the hole where the small intestine gas comes out and tie the hole with a thread! Later, as the child grows and develops, the local tissue will gradually strengthen itself, and the recurrence rate is very low. The child will have to be operated, the adults will be heartbroken! Is there a minimally invasive method? Many parents will ask. There are two types of surgery: one is the traditional open surgery, where a skin incision is made locally and the hole is separated from the outside to find the ligature; the other is laparoscopic surgery, where two small 5mm holes are made in the abdominal wall and the hole is ligated under direct vision using a laparoscope. This is what we call minimally invasive surgery. The advantages of minimally invasive surgery are self-explanatory: first, it is less invasive and faster recovery. The most important thing is that the spermatic cord in children is immature and very small, so the separation process during open surgery can easily cause damage, while laparoscopic surgery does not require separation of the spermatic cord and the hernia sac, reducing or avoiding damage to the spermatic cord; because of the small trauma, children recover quickly and without significant pain after surgery, and can generally be discharged from the hospital one day after surgery. The second is that the laparoscopic view is in the abdominal cavity, which is better able to achieve high ligation than open surgery, resulting in better efficacy and lower recurrence rate. The third is that about 20% of children who present with a unilateral hernia are actually bilateral, except that the other side is smaller and less detectable. Open surgery cannot explore the opposite side, whereas laparoscopy can clearly visualize the opposite side, avoiding missed occult hernias and the resulting secondary surgery. The next question is: At what age is it appropriate to operate on a pediatric hernia? In principle, surgery can be performed after one year of age, but of course the younger the child, the greater the overall risk of anesthesia, so it is relatively safe to perform surgery after the age of four if the hernia is not large and there are no uncomfortable symptoms. However, if the hernia mass is large and often cannot be easily pushed back after it comes out, which means that the risk of impaction is higher, we still advocate to do it as early as possible. At the same time, we must ask children to have the surgery before their bodies develop so that the recurrence rate is the lowest. Therefore, parents don’t need to be too anxious when their baby has a hernia, it is a very mature and safe minor surgery, don’t avoid surgery because you love your child, that may delay the best time to treat yo.