Many parents often go to the hospital because of bulging lumps in the groin area or scrotum of their children, even accompanied by crying and vomiting. Some parents say, “My child is very small, only a few months (or just a few days old), let’s see if it’s a hernia. What should I do now?” Looking at their anxious faces and confusion, which I often encounter, I had the idea to solve the confusion for everyone! Huang Shan, Department of Pediatric Surgery, Anqing Municipal Hospital Question 1: How did my child get this hernia? Pediatric inguinal hernia is very common from 0 to 3 years old, and it occurs in both boys and girls, more often in boys and even more often on the right side than on the left side, with an incidence of about 60% on the right side, 25% on the left side, and about 15% on both sides. Usually the sphincter, which should have been closed at birth, is not closed and the inguinal region is weaker. Combined with the fact that the child cries a lot, or has dry stools and very strenuous bowel movements, different factors that increase intra-abdominal pressure cause intra-abdominal organs such as the small intestine, colon, appendix, and even the ovaries and fallopian tubes to protrude outside the abdominal cavity through the internal ring and a mass appears in the scrotum or inguinal region. If the pressure is too tight and the protruding hernia contents cannot be incorporated into the abdominal cavity by themselves, it is called an incarcerated hernia and usually requires emergency surgical treatment. Question 2: Is my child suffering from a hernia? To diagnose whether it is a hernia, in boys, the most common clinical manifestation is a lump protruding from the groin or scrotum, which is more pronounced when exerting force or crying, and the lump can retract on its own after the child is quiet and relaxed, and the lump is often reversible. Inguinal hernias in girls are similar to those in boys and are characterized by a reversible inguinal mass, but the mass is often located in the upper part of the labia majora. The protruding organ is sometimes the small intestine, sometimes the appendix, or, if the mass is small, the ovaries. If it appears for the first time, it tends to appear after sudden exertion or crying. It does not transmit light when illuminated with a torch, which is known as a negative transillumination test. An ultrasound of the groin and scrotum can be done for further clarification and to differentiate it from other diseases. The inguinal mass sometimes has other lesions that need to be identified, such as the common syringomyelia, which varies in size with morning and evening activity and may be a traffic syringomyelia, and testicular syringomyelia (non-traffic), which is soft, non-pressurized, fluid-filled, and has a translucent capsule that is visible when illuminated with a torch and does not change in size with activity. Those that persist for 1 year usually need surgery as well. Question 3: My child is very young and has a hernia, what should I do? In very young infants, even newborns and premature babies, if a hernia is diagnosed, the mass protruding into the groin or scrotum can be closely observed if it can be reset on its own; if it cannot be reset on its own, it depends on how long the mass has been present. If you are sure that the embedded time is not long, about 2 hours, you can first find a way to make the child quiet, buttocks padded, in a hip-high head-low position, about 30 degrees more appropriate, both lower limbs properly flexed, a short period of observation, to be reset on their own. If it cannot be reset on its own, consult a doctor as soon as possible. The hernia can be gently reset. In the case of a girl’s hernia, care should be taken and early surgery is preferable because sometimes the ovaries, fallopian tubes, fallopian tubes, etc. protrude into the hernia sac and are difficult to detect and are likely to be damaged during the resetting process. Question 4: How can my child be treated for a hernia? After a clear diagnosis of hernia, if the hernia contents can reset on their own after protruding normally, it can be observed until the age of half. If it cannot heal on its own, the possibility of healing on its own again is very small and surgical treatment is preferable. If there are many chances of entrapment, early surgical treatment should be performed to prevent testicular atrophy due to impaired blood supply to the testicles caused by repeated entrapment, or damage to the intestinal canal, etc. There are two types of surgery: open surgery and laparoscopic surgery. The decision will depend on the experience of your doctor and local medical conditions. Question 5: My child has a hernia and would like to have minimally invasive treatment. Minimally invasive diagnosis and treatment has been developed in many medical fields, and many experts believe that the 21st century is the century of minimally invasive diagnosis and treatment. Of course, many people may misunderstand the term “minimally invasive”. In the case of surgery, it is not only the smallest wound that is minimally invasive, but also the overall trauma of diagnosis and treatment and the results obtained. The goal is to achieve the same or even better results with minimal trauma. Different conditions require different options, and individualized treatment plan selection should be implemented. In pediatric hernias, the vast majority can be treated with laparoscopic assistance and minimally invasive laparoscopic treatment, but open surgery is also necessary when the internal ring is very wide or when the inguinal region is quite weak and needs to be strengthened.