HERNIAS IN CHILDREN

The presentation of a mass in the groin or scrotum is always of concern to parents. A hernia is the most common mass in this location. In adults, hernias are due to a weakness in the abdominal muscles but, in children, hernias are present since birth, even if they do not become apparent until later in infancy or childhood. In children a hernia is a consequence of normal development. The testicle develops in the area of the kidney and ultimately descends from there into the scrotum. As it does, it pulls with it the lining of the abdominal cavity. In females, a testicular remnant descends down into the groin likewise pulling with it the lining of the abdominal cavity. If the opening Is a very small, only fluid (which is normally present in the abdominal cavity) is able to pass through the opening. This is called a hydrocele. If the opening is larger, the intestine is able to come down Into the sac and this is a complete hernia.

It may be difficult to differentiate a hernia from a hydrocele. A hydrocele is a collection of fluid in the sac. The opening of the abdominal cavity is small and prevents Intestine from entering the sac. A hydrocele may also be present only around the testicle and not communicate with the abdominal cavity. This latter form of hydrocele disappears by one yew of age. Hydroceles present in children over one year of age are always associated with hernias and should be repaired, as they will not resolve spontaneously.

Hernias of all types represent a potential danger to the well being of the child. The most common problem is that of incarceration, in which the hernia comes out and Is difficult to push back in. This occurs most frequently in the first year of life. When it occurs, a mass will be presented and the child may begin to vomit. If this occurs, immediate attention is required to prevent damage to the intestine or testicle.

Repair of an inguinal hernia is the most frequent general surgical operation performed In infants and children. Most hernias and hydroceles are repaired in the Day Surgery Unit. A doctor will check the child before surgery to be sure that he/she does not have a condition that would require that the surgery be postponed. In children under six years of age, we routinely operate on both sides when repairing hernias because of the high incidence of an inapparent hernia on the apparently normal opposite side. After the operation, the child is observed for a short time and then is allowed to go home with the parents. If the child has been a premature baby, the parents may be asked to have the child stay overnight for observation. There are no sutures to be removed. The scars will need to be kept dry for three (3) days after which he/she can take a full bath. Recurrence of the hernia occurs less than one percent of the time.