1. What is a pediatric inguinal hernia?
”Inguinal hernia” is the most common pediatric surgical condition in which the abdominal organs are squeezed into the unclosed sheath when the intra-abdominal pressure is increased, as if there is an extra bag next to the “egg”.
2. What is the structure of an inguinal hernia?
Imagine that the unclosed sheath in the inguinal region of a child is like a sock, and the contents of the hernia are equivalent to the “foot” sticking into the sock, the neck of the hernia sac is equivalent to the entrance of the sock, and the outside shoe is equivalent to the outer hernia cover.
A hiatal hernia consists of the hernia sac, the hernia contents, and the external hernia cover. The hernia sac is an unclosed sheath and consists of a hernia neck and a hernia body, which is also the location of the hernia ring.
3. Who is prone to it?
There are more boys than girls, and more right side than left side.
4. How to determine initially whether a child has an inguinal hernia?
If there is a soft mass in the groin or scrotum that can be pushed back to its original position and disappears when the child cries or strains to stool, but disappears when the child is quiet, the initial diagnosis is usually a hiatal hernia.
5. Are there any tests needed for diagnosis?
The majority of inguinal hernias can be diagnosed based on the clinical symptoms and physical examination of the child. If the hernia is small, inguinal ultrasound can make a definite diagnosis.
6.What are the diseases that can be easily confused and need to be differentiated?
It is mainly distinguished from syringomyelia. Depending on the size of the opening of the unclosed sphincter, if it allows the passage of abdominal contents such as intestine, it is called “hernia”; if the opening is small and only allows the passage of fluid, it is called syringomyelia. It is easily identified by clinical examination or inguinal ultrasound.
7.What are the types of inguinal hernia?
(1) Testicular hernia: the entire sphincter is not closed and the contents of the hernia can fall into the scrotum and be in the same sheath cavity as the testis; the testis can be imagined as a worm originally inside a sock, and the “foot” is in direct contact with the worm, pressing it down.
(2) Spermatic hernia: the sphincter is partially atretic near the testis, but the spermatic cord is not atretic near the ventral end, has not yet entered the scrotum, or is not in the same sheath cavity as the testis; the testis can be imagined as a worm wrapped in cloth inside a sock, and the “foot” is only in contact with the cloth.
(3) Sliding hernia: the appendix (including the appendix) or the sigmoid colon, which lacks support, drops down and becomes part of the wall of the hernia sac.
8. Is inguinal hernia caused by cough or cold?
Pediatric inguinal hernia is a congenital disorder and the increased intra-abdominal pressure (cough, crying, strenuous activity, constipation, lower urinary tract obstruction, etc.) is only the precipitating factor, while the unclosed sphincter is the real cause. It can be imagined that the most fundamental reason for the foot to reach into the sock is that the sock has an opening, and the action of reaching the foot inside can be interpreted as an increase in intra-abdominal pressure, which makes it easier to reach in when the foot is strained downward.
9.Does inguinal hernia affect fertility?
Generally not. However, if the hernia progresses to an incarcerated hernia, it may affect the ovaries in girls and may cause testicular necrosis in boys. Imagine that the foot is in the sock and the ankle is getting tighter and tighter, and the foot in the sock and what is compressed by the foot may be necrotic.
10.How to treat inguinal hernia?
Very few cases are clinically self-healing and are seen only in children with very small internal return openings. Therefore, unless there are clear contraindications (such as severe congenital heart disease), children with inguinal hernia should be treated surgically.
11. When is the most appropriate time to operate on a pediatric inguinal hernia?
After the diagnosis of inguinal hernia is confirmed, surgery can be performed if the child is in good general condition and has no other underlying diseases. However, if the hernia frequently falls into the scrotum, the surgery should be performed earlier, even in the neonatal period.
12.Does inguinal hernia surgery require general anesthesia? Will general anesthesia affect the child’s intelligence?
General anesthesia is indeed required for surgery.
There are risks associated with anesthesia, but the probability of complications is very low, and normal anesthesia will not affect the intelligence of children without underlying diseases (congenital heart disease, respiratory disease, etc.).
13.Is it possible to treat inguinal hernia with medication?
At present, there is no medicine to treat inguinal hernia. Families of children should not listen to rumors and take a chance, and cooperate with doctors when surgery is needed.
14.Can a hernia belt treat inguinal hernia?
The hernia belt only holds back what has fallen into the scrotum, but this “pre-existing hole” still exists, just as we retract our feet into our pants, we can still reach into our socks again, and the only way to do so is to surgically sew up the sock opening. It is no longer recommended for children.
15. What are the surgical methods for hernia?
(1) Traditional surgery: High ligation of the hernia sac (+ repair), which can be imagined as sewing up the opening of the sock so that the foot cannot be stretched in. The repair can be understood as sometimes the sock needs to be sewn and then reinforced with a few stitches.
(2) Laparoscopic high ligation of the hernia sac: a less invasive treatment method and the principle of treatment is similar to that of traditional surgery.
16. Which is better, traditional surgery or laparoscopic surgery?
In general, when both methods are available, laparoscopic surgery is better because it can explore whether the hernia may be present in both sides of the child. If they are present, they can be treated together, with smaller incisions and less trauma. The chances of recurrence after surgery are comparable between the two types of surgery, about 2 in 1,000.
17. Is the surgical procedure for hernia in children the same as that for adults?
No. Pediatric hernia usually requires only a high ligation of the hernia sac neck (as if it were a ligature of an open pouch opening). For preschool children and giant hernias can be treated according to a modified surgical approach for adults (strengthening the anterior wall of the inguinal canal and making a repair).
18.What preparations are needed before inguinal hernia surgery?
Routine preparations before surgery include blood tests (routine blood, liver and kidney function, blood sugar, coagulation function, hepatitis B complete set, etc.), routine urine and stool, chest X-ray, electrocardiogram, inguinal and scrotal ultrasound, and heart ultrasound for children under one year old.
19.Can I get out of bed and walk and do normal activities after inguinal hernia surgery?
Yes, the child’s daily activities are generally not affected, but strenuous activities (such as running, high jumping, diving, etc.) should be avoided for 3 months.
20.Do I need to use antibiotics after pediatric hernia surgery?
Generally, antibiotics are not needed in routine cases, but can be used once prophylactically if the hernia is repaired. If it is an incarcerated hernia, the doctor should decide which level of antibiotics to use according to the damage of the hernia contents.
21.Does the surgical treatment of inguinal hernia affect fertility?
No, the surgery is only to ligate the neck of the hernia sac (the “sock” mentioned before, and the “bug” [testicles] inside will not be touched), and no reproductive organs will be involved.
22. What are the precautions to be taken after inguinal hernia surgery?
After surgery, we should pay attention to reduce the factors that increase intra-abdominal pressure, such as chronic cough, constipation, lower urinary tract obstruction, etc., which need to be treated and controlled in time.
23.What is an incarcerated inguinal hernia?
It is a common complication of pediatric inguinal hernia, and if not treated in time, serious consequences such as intestinal necrosis and intestinal perforation may occur, and even life threatening.
24. Is there a difference between mild and severe inguinal hernia?
Inguinal hernia is divided into inguinal hernia and inguinal incarcerated hernia according to whether the contents of the hernia can be returned by themselves. Inguinal hernias do not usually cause serious consequences, but inguinal hernias can be life-threatening if left untreated.
25. What are the manifestations of inguinal hernia?
(1) In children with a history of inguinal hernia, a large, hardened mass can be felt in the male scrotum or female lower abdomen near the perineum or at the base of the thigh when it is embedded, and it is painful when touched.
(2) The child presents with crying, vomiting, and no defecation or discharge from the anus.
(3) Later, there will be fever, dehydration, poor mental health, blood in stool, etc.
26.Which department should I go to if I suspect an inguinal hernia has occurred?
Once a child is found to have an inguinal hernia, general pediatric surgery is the first choice in areas where there is a specialized hospital; if there is no specialized hospital for children, general surgery of a general hospital is preferred.
27.Does inguinal hernia have to be operated immediately?
It is not necessary to operate immediately when an incarcerated hernia occurs. Generally, it is considered that within 12 hours, there is no sign of intestinal necrosis before manual repositioning can be considered, and surgery can be scheduled 2 to 3 days after successful repositioning.
For more than 12 hours, or if the resetting fails, emergency surgery should be performed.
28.Can I eat immediately after resetting inguinal hernia?
Generally, do not eat immediately (including drinking water), and observe at least 6-8 hours after resetting, paying special attention to abdominal pain, abdominal hardness, etc. If there is no abdominal pain, drink water and eat only after there is no discomfort to avoid delayed intestinal perforation and intestinal necrosis, etc.
29.When inguinal incarcerated hernia occurs, which cases need immediate surgical treatment?
(1) The duration of impaction exceeds 12 hours.
(2) The child is obviously in poor spirits, fever, blood in stool, dehydration, etc.
(3) neonatal incarcerated hernia: because the exact time of onset is not clear and the rate of intestinal necrosis in neonates with incarcerated hernia is high
(4) female incarcerated hernia: the ovaries and fallopian tubes are not easily repositioned
(5) Unsuccessful manual repositioning or repeated manual repositioning of the child, but intestinal injury or intestinal perforation still cannot be excluded.
30.Can minimally invasive laparotomy be performed for inguinal hernia?
It should be judged according to the specific situation of the child. Laparoscopy is possible to observe the inside of the scrotum being pushed back into the stomach under direct vision, so as to see more clearly whether there is necrosis or perforation of the intestine; if the intestine needs to be removed, it can be removed through a 2cm-long incision in the curved belly button, and the intestine can be raised outside the abdominal cavity.
31.Why is there bloody stool discharge in inguinal hernia?
This is a very serious situation.
If the contents of an incarcerated hiatal hernia are intestinal tubes, the intestinal wall and its ligament can be compressed at the neck of the hernia sac, firstly, the venous return is blocked and the intestinal wall is bruised and edematous; after the pressure is increased, the arterial blood flow can be reduced and finally, the intestinal tube is completely blocked and necrosis occurs, and bloody stool will appear.
It can be imagined that the foot stuck in the sock has been tightly strangled at the mouth of the sock, the blood in the foot can not flow out, but at this time the blood outside can still flow in some, the foot becomes a kind of blue-purple, looks more swollen, and finally strangled more and more tight, even the blood outside can not flow in, then this section of the “foot” (intestine) will become black The “foot” (intestine) will become black and necrotic. So, the contents of the intestine are slowly discharged and become bloody stool.
32. What is the recurrence of inguinal hernia?
Hernia surgery is like tying the open “pouch”. The main reason for recurrence is related to the increase of intra-abdominal pressure, recent constipation, repeated coughing and strenuous exercise of the child may reopen the tied pouch. Avoiding these causes can greatly reduce the recurrence of hernia.