Syringomyelia and inguinal hernia are common diseases in pediatric surgery. Every time I go to the clinic, there are several parents who are torn between the different explanations of the doctors or hospitals, and every time I do the same.
Is my child a hernia or a syringomyelia?
The parents took their child to a doctor who said it was a hernia and needed surgery, and to another doctor who said it was a syringomyelia and needed surgery. The parents were confused and angry. It was irresponsible to operate without being sure what the disease was, so they took the child into a third hospital.
During the embryonic period there is a channel between the abdomen and the groin, called the sphincter, which normally closes in the last trimester of pregnancy. However, if this channel is not closed after birth, if certain organs that should have been in the abdomen (intestines, ovaries, fallopian tubes, greater omentum) pass through this channel down into the groin or scrotum, it is called a hernia; if ascites collects in the groin or scrotum through this channel, it is called a syringomyelia (in boys) or a Nuck cyst or round ligament cyst (in girls).
Generally, through symptoms and physical examination, the doctor can determine whether the mass is a hernia or a syringomyelia, but sometimes there is a bias in judgment when the mass is only in the inguinal canal area or when there is both omentum, intestinal canal and fluid in the sphincter cavity, but it does not really affect the treatment, and the surgical procedure is basically the same. Of course, an ultrasound would be more helpful in the preoperative diagnosis.
What is the best time for my child to have surgery?
When a child is found to have a hernia soon after birth, parents always think about it and ask about it whenever they hear that someone is studying medicine. Some people say that the hernia will grow and heal on its own and there is no need for surgery; some say that it should be done when the child is three years old; others say that they heard that it should be done when the child is one year old; others say that the surgery should be done as soon as possible and that the intestines of so-and-so’s child were necrotic when the surgery was done late. Parents are so confused.
For hernia, the possibility of self-healing is relatively small, and there is indeed a risk of impaction (stuck), which can be complicated by intestinal necrosis and ovarian necrosis, so it needs to be handled more actively. In the past, later surgery may have been advocated due to the technical risks of surgery and anesthesia. It is now considered that surgery and anesthesia are not contraindicated in infancy (within one year of age) either, especially if there has been previous impaction, and early surgery is warranted.
For syringomyelia, especially in newborns, there is a good chance of self-healing and there is no risk of impaction as described above, so the timing can be appropriately late, for example, until after one year of age. However, for syringomyelia with a lot of tension, because of its compression of the spermatic cord or testicles, it can still be treated earlier.
What are the risks if I am determined not to have surgery?
For hernia, the main thing is the impaction, which is manifested by the abdominal contents entering into the hernia and then stuck there and cannot be retracted, and finally there is ischemic necrosis, or even intestinal perforation, being forced to the intestinal canal or ovarian oviduct, or there is testicular necrosis or testicular atrophy after compressing the testicular blood supply.
In the case of syringomyelia, the fluid encircling and compressing the spermatic cord and testes will affect the blood supply to the testes or raise the temperature of the environment the testes are in, both of which are detrimental to testicular development.
So please do not persist in challenging science, regrets can always be seen.
There is no medicine for hernia or syringomyelia, so please don’t ask me if herbal medicine will work or not.
What other problems can there be besides a hernia or syringomyelia?
Because hernias or syringomyelia are the most common, when parents or even doctors see a swollen groin or scrotum, the first thing that comes to mind is probably a hernia or syringomyelia. And the problems of testicular tumors, scrotal lymphangiectasia, and hermaphroditism (disorders of sexual development) are just ignored.
So an enlarged groin or scrotum is definitely not just a hernia or syringomyelia, make sure you see a pediatric surgeon.
Is lumpectomy or open surgery better?
This is probably one of the most difficult questions for every parent. If you ask a lumpectomy surgeon, they will say lumpectomy is better; if you ask an open surgeon, they will say open is better. I do both lumpectomy and open surgery, and I can answer this question very neutrally, each has its own advantages.
Open surgery has been tested by history, and lumpectomy has matured after more than 10 years of development.
Both are good, and both have a recurrence rate of less than 1%. All of them are right, but each has its own advantages. For example, a child with a left-sided hernia may already have a hidden hernia on his right side, but it has not yet manifested itself, and after the open surgery on the left side, the right side manifests itself, and the right side needs to be done again. If the first surgery is lumpectomy, we can see whether there is a hidden hernia on the right side or not, and if there is not, it is good, and if there is, we can take care of it all together. But the cost of two openings may also be less than the cost of one lumpectomy. So it’s not a question of whether it’s good or not, it’s a question of whether it’s appropriate or not. You make your own choice and I’ll do it. I don’t like to call lumpectomy a minimally invasive procedure, as if open is more invasive. At least for a hernia or syringomyelia, open surgery may be a little less invasive, and the child may not feel uncomfortable for the first two days after surgery.
For the following cases, I prefer to recommend lumpectomy. One is a hernia in a girl, because it is the round ligament that passes through the inguinal canal and not the vas deferens, so it is much easier to separate the hernia sac laparoscopically without the risk of ligation to the vas deferens, and it is also possible to find out about the internal genitalia of the girl’s uterus and ovaries. Second, recurrent hernias, if they are recurrent or new after open surgery, it would be very difficult and risky to operate through the inguinal canal again, and lumpectomy provides a new way to avoid these problems. Third, with bilateral hernias, lumpectomy allows simultaneous diagnosis and management of both sides. Girls and bilateral hernias and lumpectomy are a perfect match!
Children’s groins are generally shorter and childhood hernias generally require only a high ligation of the hernia sac, not a repair, much less a patch. The lumpectomy is basically a high ligation of the peritoneum at the inner ring, whereas open surgery can easily add inguinal canal repair in addition to high ligation. Therefore, if the hernia is huge and it is obvious that the abdominal wall is weak, open surgery is recommended if repair surgery is more reliable.
Is surgery for hernia or syringomyelia safe?
Yes, accidents are very, very rare.
The main complications of surgery are: damage to the vas deferens or spermatic vessels, hematoma formation, wound infection, medically induced cryptorchidism (the testicle is in the scrotum before surgery but remains in the groin afterwards), and recurrence of the hernia. An experienced surgeon will make every effort to avoid these problems during surgery.
What is a recurrent hernia or a new hernia?
The child previously had a hernia on the left side, the left side healed, and then the right side developed a hernia again. This is not really called a recurrence. A recurrence is when the same type of hernia appears after surgery on the same side, for example, a left hernia after surgery is called a recurrence, and a left straight hernia is not called a recurrence.
A new hernia is a hernia that is not related to the previous hernia. For example, a left hernia followed by a right hernia. A right-sided hiatal hernia is followed by a right-sided straight hernia. Children basically have a hiatal hernia and rarely a straight or femoral hernia.
Pre- and post-operative considerations for syringomyelia and hernias.
Embedded hernias that have failed to be repositioned by manipulation or have been too long in duration require urgent surgery without delay. In addition, syringomyelia and hernia are elective surgeries and it is safer to choose a time when the child is in relatively good health, for example, after the diarrhea or respiratory infection has healed.
After hernia and syringomyelia surgery, the wound will be covered with a clean dressing to keep it clean and dry. Do not wet water for a week and change the dressing promptly if it is stained. It is not necessary to use antibiotics after surgery. The dressing will be changed about three days after surgery and the wound will be observed. Anal fever suppositories or oral painkillers can be used to relieve pain for two or three days after surgery. Try to avoid strenuous activities for one month after surgery, while general daily activities need not be restricted.
Please follow up as soon as possible if
The child is excessively irritable or in poor spirits; bloating, vomiting, fever, heavy wound bleeding or severe scrotal swelling.