When your child’s ovaries are in the mother’s womb, they form in their own abdomen and pass through the inguinal canals near birth and descend into the bags, after they pass, the inguinal canals are closed. If it is not closed, when the intra-abdominal pressure increases, the organs in the abdomen, mostly intestines in boys and ovaries in girls, move towards this channel; This is called an inguinal hernia.
Prematurity (premature birth), low birth weight, family history of inguinal hernia, hydrops, ascites, ventriculoperitoneal shunts, connective tissue diseases may predispose to inguinal hernia.”
The symptoms of inguinal hernia are as follows ;
A swelling appears in the groin area when the child cries, coughs or strains, or when he/she does too much activity. When the child relaxes, lies down or sleeps, or when you press softly on this swelling with your hand, the swelling disappears with a gaseous sound called a “guck”. This physical examination finding is sufficient for the diagnosis. The swelling may become evident and disappear. Therefore, we may need to repeat the physical examination with the checks we make soon. In this case, if we cannot detect the hernia, it may be necessary to resort to ultrasonography.
When an inguinal hernia is detected by both physical examination and ultrasonography, the only treatment is surgery. Surgery is scheduled shortly after the diagnosis is made. In case of a more serious concomitant disease, if the baby is premature or if there is a more important anomaly related to other organ systems, the surgery can be postponed in a controlled manner.
Generally, families may have the idea that our child is small and we should have this surgery when the child grows up. This can lead to more serious health problems. If inguinal hernias are not operated, there is a 5-18% risk of incarceration or strangulation (suffocation). Abdominal pain, vomiting, hardening of the swelling in the groin, bruising may be seen in the child. These indicate that the abdominal organs (small intestine, colon, omentum, appendix, ovary) are compressed in the hernia sac. And it requires urgent surgical intervention. ”
Inguinal hernia is seen in an average of two out of every 100 children. Inguinal hernia is seen in boys at a rate of 80-90%. Inguinal hernia can be on one right or one left side, or it can be detected on both sides at a rate of 10%. The incidence in premature infants is three times higher than in normal-weight infants. One third of these disorders are diagnosed within the first 6 months.
The incidence of inguinal hernia in childhood is 4 percent in all societies.
Treatment Methods in Inguinal Hernia;
Hernia should be surgically repaired as soon as possible in order to prevent the risk of suffocation of the abdominal organs. Due to the risk of anesthesia in premature babies, one or two months may be expected. The surgery is performed under general anesthesia. A very small incision is made in the groin area, after the hernia sac is repaired, the skin incision is closed with dissolving sutures. The incision is covered with a small dressing. Post-operative pain is under control as long-acting drugs are used on the surgical site during the procedure.
There is no treatment alternative for inguinal hernia other than surgery.
Inguinal hernia repair is in the category of day surgery. The child applies to the hospital for surgery on an empty stomach, eats his meal 3 hours after the operation, and is discharged on the same day. There is no need to stay in the hospital.
Things to consider before and after the surgery:
Except for premature and newborn babies, juicy food is started shortly after the operation and sent to their homes. Usually, there is no need for activity restriction. It is recommended to avoid heavy sports activities in older children. There may be swelling in the surgical area and in the bag due to the procedure, normally these swellings disappear slowly within 1-2 months
Success rate and recurrence risk in inguinal hernia surgeries:
Hernia recurrence is very rare in long-term follow-up. However, recurrence can be seen in some disease groups such as connective tissue and in prematures. In unilateral inguinal hernia, a hernia may occur on the opposite side. Especially if there is an inguinal hernia on the left side, a very high rate of hernia may occur on the right side. In this case, reoperation is necessary. In long-term follow-up, no problems occur both visually and functionally.
Also called water hernia (hydrocele); If the inguinal canal does not close after birth, but remains narrowed enough to allow only the fluid in the abdomen to pass, it is called a “water hernia” (hydrocele). Typically, the child has a mass in the bag that increases and decreases with movement. It may appear gray-purple from the outside. Since this small opening in the inguinal canal can close by itself until the age of 2, water hernias do not need to be operated before 1 year of age. However, surgery may be delayed in hydroceles that are large enough to compress the testis. It is not possible to discharge the water hernia with a needle. Because this water will accumulate again and your child’s testicles will be at risk of infection for nothing. The operation of water hernias that continue after 1.5-2 years of age is the same as inguinal hernias.
