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A hernia occurs when a portion of an organ or tissue within the abdomen, such as the intestines, protrudes through a weakness in the muscles of the abdomen. A soft bulge is seen underneath the skin where the hernia is located.
A hernia that occurs in the groin area is called an inguinal hernia.
Between 12 to 14 weeks of fetal development, the testicles or ovaries form in the abdomen near the kidneys. They gradually move down into the lower part of the abdomen, through a small tunnel called the inguinal canal, as the baby continues to grow. As they move down, a portion of the peritoneum (a thin layer of tissue that lines the inside of the abdomen) that attaches to the testicle is drawn with it into the scrotum, forming a pouch or sac. A similar process occurs in girls as the round ligament of the uterus descends into the groin at the labia. This sac is known as the processus vaginalis and normally closes shortly after birth. This eliminates any connection between the abdominal cavity and the scrotum or groin. When closure of the processus vaginalis is delayed or incomplete, it may stretch and eventually become a hernia. The stretching of the processus vaginalis creates an inguinal sac, allowing organs to extend from the abdomen and enter the sac. If fluid, rather than organs, builds up and remains in the sac, the child has a hydrocele.
Approximately 80% to 90% of inguinal hernias appear in boys. They are more common on the right side, but in about 10% of cases, they occur on both sides (bilaterally).
An inguinal hernia can occur at any age, but one-third of hernias in children appear in the first six months of life.
The diagnosis is made by a thorough medical history and careful physical examination by a physician.
If the bulge can be gently pressed back into the abdomen, the hernia is termed reducible. If it cannot be pressed back into the abdomen, the hernia is known as incarcerated (irreducible).
When a hernia becomes incarcerated, infants or children will show signs of irritability and may vomit. They may also have loss of appetite, abnormal bowel patterns, and/or tenderness of the groin area and swelling of the abdomen.
With a prolonged period of incarceration, the blood supply to the intestine could be cut off, causing it to die. This is referred to as a strangulated hernia -- a life-threatening situation that requires urgent surgical attention.
Inguinal hernias require an operation, and to avoid the risk of abdominal organs becoming incarcerated, this is generally done as soon as possible. In premature infants, who are only several months old, surgery may be postponed for two to three months to ensure that the lungs are functioning properly.
Surgery is carried out under general anesthesia. There are 2 different ways in which a hernia can be repaired, open or laparoscopic surgery, your child’s surgeon will decide the best way for your child. With open surgery, a small incision is made in the groin. Laparoscopic surgery uses small cuts and a camera—less invasive. The hernia sac is identified and repaired. The incision is closed with dissolving stitches. Incision glue and/or Steri-Strips (strong tape that sticks for seven to 10 days) are used to seal the surface of the incision. During the procedure, a generous amount of long-acting numbing medicine (local anesthetic) is injected around the incision to help control pain.
Most children who undergo hernia repairs go home the same day after a short stay in recovery; however, premature infants may require an overnight stay. Most children are able to return to normal activities, even sports, with no restrictions within a few days.
In cases where a large inguinal hernia extends down into the scrotum, the scrotum may swell after surgery. It may appear as though the hernia has come back. This swelling is normal and will go away on its own within several weeks to months.
After surgery, the risk of the hernia returning is extremely low. However, the risk is known to be higher in premature infants and in children with hydrocephalus, connective tissue disorders, chronic lung disease and chronic renal failure.
Home to internationally renowned pediatric surgeons, our Level I Children's Surgery Center delivers expert, compassionate care. Through advanced training and multidisciplinary collaboration, we uphold the highest standards in surgical excellence and patient-centered care.
Last Updated 11/2022
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