What is an inguinal hernia?
An inguinal hernia happens when tissues or organs from inside the abdomen - usually the intestine - push through the abdominal wall into the groin. This is the most common surgical problem affecting otherwise healthy babies and children.
In boys, an inguinal hernia can reach down to the testicle, making a prominent swelling on one side of the scrotum. In girls, an inguinal hernia can present with a rounded lump in the groin and the most common organ involved is typical the ovary, which has been displayed from inside the abdomen to the groin.
Written by: Stefano Giuliani
Written on: 21.02.19
Inguinal hernia: spot the signs in your child
As a parent, it's difficult not to worry if you notice an inguinal hernia, which presents itself as a visible bulge in the groin or scrotum, of your little one. Mr Giuliani, expert paediatric surgeon, explains more about the sings of an inguinal hernia and what you should do if you notice one.
What causes an inguinal hernia?
Babies with an inguinal hernia are usually born with an open connection between the tummy and the groin, which has failed to disappear after birth. The hernia is usually becoming evident a few weeks or months after birth as the baby becomes stronger, and the pressure inside the abdomen increases.
Even toddler and older children may have the hernia connection present since birth, but they develop a visible and painful hernia only later in life when they become more active and during sports.
It is known that your child is at higher risk of having an inguinal hernia if you have a family history of inguinal hernias.
Symptoms of an inguinal hernia
In babies, the most common sign of an inguinal hernia is a visible bulge in the groin which can cause an asymmetry between the right and left side. Usually, the side affected by the hernia shows a lump which is soft and non-tender. In older children, a similar lump in the groin is present, and it gets bigger if your child is standing up or straining.
Around the age of four years, your child will be able to tell you if the inguinal hernia is associated with pain or discomfort.
To confirm the diagnosis of inguinal hernia, it is important to take a picture of the lump in the groin when it is clearly visible and to bring it to your appointment with Mr Giuliani. This will help Mr Giuliani to confirm the diagnosis and advice on the best management.
Inguinal hernias need to be repaired with a surgery as soon as possible to reduce the risks of complications, such as the intestine getting blocked or strangulated in the groin. If your child is complaining of severe groin or testicular pain persisting for more than half an hour you should bring your child to the closest A&E to get checked.
Mr Giuliani is usually available to review your child within 24-48 hours and this will be ok for all the non-urgent cases.
Treatment options for an inguinal hernia
After Mr Giuliani has confirmed the diagnosis of inguinal hernia, he will discuss with you the best treatment option based on your child age and risk to have a bilateral inguinal hernia or an associated umbilical hernia.
The two types of surgery available are the laparoscopic hernia repair (key-whole surgery) and the open hernia repair. For both the techniques, different from the adults, there is no need to use mashes or prosthesis as the hernia is safely repaired with one or two stitches.
The laparoscopic hernia repair is based on a minimally invasive technique, which involves the surgeon operating via small incisions (3mm) made in the abdomen. Your child will be put asleep by the best and most experienced neonatal and paediatric anaesthetist working in Mr Giuliani’s Team. Before the incisions are made, the abdomen is inflated with a special gas to make internal organs easier to be seen. A tiny tube carrying a 3mm camera is then inserted through one incision, while small surgical tools (3mm) at the end a fine stick are inserted through other incisions to repair the hernia. This laparoscopic hernia repair is preferred in babies or when a child has bilateral inguinal hernias or when there is an associated umbilical hernia. The surgery lasts about an hour.
The open hernia repair is based on a small incision in the groin to expose and fix the hernia sac with stitches. The general anaesthesia and the time of the operation are similar to the laparoscopic one. This technique is preferred for monolateral hernias in older children. In girls after the age of one, the open hernia repair has the advantage to have a tiny incision (8-10mm) which will not be visible in the long term.
Both these surgical techniques to fix inguinal hernias are perfoermed as a day case without an overnight stay in the majority of the cases. The recovery is usually fast and requires a few days at home and no physical activities for three weeks.
Mr Giuliani will do his best to accommodate a date for the surgery within 1-2 weeks after the initial consultation to reduce the risk of complications.
"Mr Giuliani provided outstanding care to our 8-week old Son who was born with bilateral inguinal hernias. He was calm and friendly, and his professionalism and expertise left us feeling confident that our Son was in safe hands. We cannot thank him enough for the care he provided, and for making two anxious parents feel very reassured. We would thoroughly recommend him!"
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