Pediatric inguinal hernia (commonly known as hernia) is the most common condition in pediatric surgery. A hernia is also often confused with a traffic syringomyelia (commonly known as scrotal effusion), but in fact they are not quite the same. In terms of cause, if the lumen is large enough to allow the intestines to come out, it is a hernia, and if the lumen is small enough to allow only the ascites in the abdominal cavity to come out, it is a syringomyelia. 1. What are the causes of hernia? In the early stages of fetal development, the boy’s G-sphere is in the abdomen, but by about seven months of pregnancy it must descend from the abdomen to the scrotum outside the abdomen, so the abdominal wall is left with a canal. In girls, although there is no G-sphere descent process, there is a similar structure, with a ligament extending from the abdomen to the pubic bone through this duct. In medical terms, this small hole is called the “internal ring”. Most babies are born with this ring closed, but if it is not closed, the intra-abdominal organs can protrude from it and form a hernia. If the hole is so small that only ascites is allowed to come out, then it is a syringomyelia. A hernia in children, although not necessarily symptomatic at birth, can still be considered a congenital disorder in terms of cause. In 30 to 50 percent of cases, the internal ring will never be completely closed for the rest of their lives, but will only be tightly constricted and therefore will not produce a hernia, but there is still a chance that a hernia will occur later in life. The contents of the bulging mass are most often the small intestine and sometimes the ovaries in girls. 2. What is the incidence of hernia in babies? Can girls have a hernia too? Hernia is a very common surgical problem no matter what age. According to statistics, the incidence of hernia in children is 3-7%, a fairly high incidence. Parents often think that only boys have hernias, but in fact, girls can have them too, just with a lower chance. The male to female ratio of hernias is 5:1. Because hernias are very common, although only one in five, hernias in girls are still very common. 3. What are the symptoms of a hernia? How is it diagnosed? The symptom of a hernia is that it bulges out at the groin and is especially noticeable when standing. Sometimes the size of the left and right scrotum is asymmetrical. Smaller hernias may normally be asymptomatic, but may become visible in the groin or scrotum if the abdomen is strained, for example, when crying, coughing, relieving stool, or exercising. The lump often disappears on its own after bed rest or sleep. Larger hernias may have the discomfort of swelling. A hernia is usually not painful, but in case of painful crying, it may be an impaction. The diagnosis of a hernia is not difficult and can usually be determined by simple visual inspection and palpation. If necessary, ultrasound is needed to assist in the diagnosis. 4. What is an incarcerated hernia? A hernia is usually not painful, but in case it is painful, it may be an incarcerated hernia. An incarcerated hernia is a condition where the intestine or ovary is stuck in the inner ring, causing poor blood circulation, and the patient may experience vomiting, dehydration and shock due to intestinal obstruction. Over time, the intestine becomes necrotic or perforated due to ischemia, resulting in peritonitis, which can be life-threatening if not treated immediately. Sometimes, if the hernia is embedded for a long time, it can also cause ischemia and normal necrosis of the testicles and later atrophy. If the ovary is embedded and necrotic, it can have the serious consequence of not being able to have children. These cases are not uncommon in clinical practice. Therefore, if the inguinal mass does not retract for a long time along with pain and crying, one should think about the possibility of an ingrown hernia. Parents and doctors should think about the possibility of an incarcerated hernia for those cases of unexplained intestinal obstruction such as crying and vomiting, and should therefore look at the groin during the physical examination. For parents whose own children have hernias, it is even more important to remind the doctor that they have a hernia when seeking medical attention to avoid delaying the diagnosis and causing adverse consequences. 5. Will a hiatal hernia heal on its own? It is often said that a hernia will heal on its own and surgery is not necessary. Will a hernia really heal on its own? This question is usually due to the confusion between hernias and syringomyelia. Because the symptoms and causes are similar, but syringomyelia has the potential to heal on its own before the age of one, “hernias heal on their own” often refers to syringomyelia. Hernia rarely heals on its own, but sometimes the symptoms are not obvious. 6. How is a hernia treated in babies? What are the negative consequences of delayed or untreated hernias? There is no medication for hernia and the only treatment is surgery; the often mentioned hernia belt only provides some relief for a large hernia. Surgery involves ligating the inner ring so that the passage of the hernia disappears. The surgery takes about 20 minutes for a skilled pediatric surgeon and is a relatively safe procedure. Although the surgery can be done at any age, it is generally best done around the age of 1 year. You can be discharged the same day after the procedure, or you can stay in the hospital for 1-2 days for observation and return home. Many pediatric surgery centers use the concept of a one-day ward, which means going home after a few hours of observation after surgery, at a modest cost. Because the surgery is so minimally invasive and safe, and the cost is so small, it is not worth the risk of delaying the surgery to risk an ingrown hernia. As for the “minimally invasive surgery” mentioned by many parents, minimally invasive surgery does not only refer to laparoscopic hernia surgery, but also conventional small inguinal incision surgery, some of which even heal with basically invisible scars, is minimally invasive. Laparoscopic surgery also has its own advantages and is suitable for some bilateral hernias, giant hernias and recurrent hernias, with the disadvantage of high cost and the need for pneumoperitoneum. Therefore, the choice of surgical method needs to be based on the experience of the surgeon and not “minimally invasive” for the sake of “minimally invasive”. 7.Is there anything I should pay attention to after the surgery? No special care is needed after the hernia surgery. The wound will be slightly painful for 1-2 days, and the child can usually move and eat as usual after waking up from the anesthesia. There is usually no need for antibiotics or fluids, and no need to remove stitches. However, the wound excipients need to be protected from drying to prevent wetting. 8. Recommendations Hernia in children is very common and surgery is the only option available. Surgery is also safe and parents do not have to worry about delaying treatment because the child is too young. In case intestinal necrosis occurs before seeking medical attention, it increases the risk in all aspects instead. As for the timing of surgery, it is generally difficult for a hernia to heal on its own if it is older than one year old, and it is best to complete surgery during preschool.