Pediatric Inguinal Hernia
Overview
Pediatric inguinal hernia is a congenital disorder caused by failure to occlude the peritoneal sphincter during the descent of the testis during the embryonic period, and can develop in the neonatal period. It is more common in males, with the right side being 2 to 3 times more common than the left side, while bilateral cases are rare, accounting for about 5% to 10% of cases.
Symptoms
1. Most of them develop within 2 years of age and usually appear in the first few months of life.
2. the main manifestation is the appearance of reducible masses in the inguinal region, (when crying or other reasons to increase intra-abdominal pressure, the masses can be significantly increased, quiet, lying down, sleep, the masses can be reduced or completely disappear, generally does not hinder the activities, does not affect the normal development of children).
Older children may report a feeling of swelling. 4.
4. if the hernia contents are embedded, (painful packet, abdominal distension, vomiting, easy to cause fever and other symptoms of infection and poisoning when the hernia contents are necrotic).
Diagnosis
1. an oval-shaped mass is seen locally, which may descend to the scrotum when it is larger.
(The appearance is quite heart-shaped, soft, elastic, unclear upper boundary, the mass has a stalk leading to the abdominal cavity and can be easily returned into the abdominal cavity, and a grunting sound can be heard, the mass cannot be re-expanded by compression of the inner ring, and the impulsive sensation can be detected when the child coughs or cries, etc.).
2. For children with a history of protruding inguinal masses, the inguinal region temporarily can not find the masses, (infants can stimulate their crying or pressure on the abdomen older children can make them cough, hold their breath, bulge, run and jump after re-examination can find the masses and clear diagnosis).
3. Negative transillumination test.
4. Ultrasound can assist in the diagnosis.
Complications
1. repeated descent of the hernia contents and entrapment tend to cause local hyperplasia and hypertrophy, adhesion of the spermatic cord and vas deferens.
2. Intussusception of hernia contents may cause intestinal necrosis, ovarian necrosis and other hernia contents necrosis.
3. vomiting and poisoning caused by ingrown hernia contents can lead to electrolyte disturbance and dehydration, and finally cause various kinds of shock.
Treatment
Surgery should be performed after diagnosis (as early as possible after the age of 1 year, and at any time for recurrent intussusception)
Methods.
1, conventional surgery (hernia sac high ligation, currently we routinely add tight subcutaneous ring or strengthen the anterior wall of inguinal canal to make the recurrence rate of hernia 0, the surgical incision is about 2cm).
2.Surgery is performed in the same way as above, taking intracutaneous cosmetic suture.
3, Minimally invasive (laparoscopic high ligation of the hernia sac with only about 0.3 cm incision in the groin).