Inguinal hernia is the most common surgical problem of childhood. It results from a small sac that comes through the inguinal ring that is normally open during fetal life and closes around the time of birth. For reasons we don't understand, it does not close in some infants. This sac then makes a pathway for abdominal organs to come through the inguinal ring into the groin. In boys, the organ is usually a loop of bowel and, in girls, it may be bowel or an ovary. In boys and girls, the hernia first appears as a bulge in the groin, and may appear and disappear, or may be present all the time. It will usually "pop out" when the child cries or strains. If only fluid comes through the inguinal ring into the sac, the problem is called a hydrocele.
Why does my child need surgery?
Inguinal hernias never go away without treatment. Furthermore, if the sac is left open, a loop of bowel or other organ may become trapped or incarcerated (strangulated) in the sac. Once trapped, the organ, which comes through this very small opening, can swell and compress the blood supply that is pulled along with it. Without adequate blood supply, the organ trapped in the hernia sac can become damaged or even die. If your child has an incarcerated hernia, he or she may have a hard, red, painful lump, may vomit, may be unwilling to eat and may stop stooling. This is an emergency. If this happens, your child should be taken to your pediatrician's office or, after hours, to the local emergency room. The pediatrician or emergency room doctors will contact us. If the hernia cannot be pushed back (reduced) into the abdominal cavity, your child will need immediate surgery.
What does the surgery involve?
The surgery takes about one hour. Your child's pediatric surgeon will close the opening to the hernia sac laparoscopically, using small instruments through 2 or 3 tiny incisions.
In some children, the hernia sac will need to be closed through a very small (about one inch) incision in the groin. This is called an "open" operation. The pediatric surgeon will tell you which approach is best for your child. Children less than one year of age, can have an open sac on the other side that could become a hernia later. Your child's surgeon may use a tiny telescope to look for a hernia on the opposite side and close it if there is one. The surgeon will discuss this with you before the operation. There will be no stitches to remove from the skin later because the stitches will all be under the skin and will dissolve on their own. Your child's skin will be covered with small bandages called Steri-strips®.
How long will my child stay in the hospital?
After the operation your child will return back to the recovery area, and you can be with him or her while he or she is waking up. Some children are upset and confused as the anesthesia starts wearing off. This is temporary and not unusual. Most children will go home as soon as they are awake and able to drink liquids after the operation. If your child was born prematurely, or has other health problems, the surgeon may keep him or her in the hospital overnight to monitor his or her breathing.
Most children will go home as soon as they are awake and able to drink liquids after the operation. If your child was born prematurely, or has other health problems, the surgeon may keep him or her in the hospital overnight to monitor his or her breathing.
At the end of the operation, the surgeon will put a long-acting, numbing medication into the incision. Most children only need Acetaminophen (Tylenol®) or Ibuprophen (Motrin®) by mouth every four to six hours for the first 24 hours after surgery. If your child is still uncomfortable, call our office and we may prescribe something stronger.
Care for Dressings
Gauze and clear plastic dressings may be removed two days after surgery. Under the gauze, there may be a small amount of blood. This is normal. The skin surround the incision may be red and bruised, and the incision will be slightly swollen. Over the incision, there may be Steri-strips® that can be worn into the bath and can be removed one week after the operation.
In most operations, the wound is closed with dissolvable suture(stitches). These stitches are under the skin and do not have to be removed. In some children these stitches may come through the incision about 4 weeks postoperatively. This may be associated with a little local redness and pus and it may involve an end of the incision or a larger portion. This is normal and is best treated by gently cleansing the area with soap and water and waiting. When the suture falls out or completely dissolves, the wound will heal. If your child has worsening redness, swelling pain of the incision and a fever within 2 weeks of the operation, please call our office.
Swelling After Surgery
There will be some swelling at the incision. In boys, swelling of the scrotum is normal after the hernia surgery, and may take several weeks to go away completely. In girls, there may be some swelling in the skin folds below the incision. For both boys and girls, you will be able to feel a firm ridge under the incision that lasts several months. This is called a "healing ridge", and is where the tissues are sewn back together.
Your child may bathe or shower two days after surgery. Before then, he or she may take a sponge bath, but the Steri-strips® should be left on if they are present.
There are no specific restrictions. Children will limit their own activity until they feel better, and most are back to normal activity in a day or two. Some children may require several days to feel better.
Do I see the surgeon again after the operation?
One or two weeks after the operation a nurse from our office will call you to see how your child is doing. A visit to our office about one month after the surgery is a good idea. Call our office if you're worried about how things are going after the surgery.
Call our office at 415-476-2538 for the following:
- Any concerns you have about your child's recovery
- A temperature of 101°F or higher
- A red incision
- Increasing pain and tenderness at the incision
- Any liquid coming out of the incision