NAVIGATION

Don’t Wait on this Common Childhood Operation

Wei CHENG, Pediatric Surgeon

An inguinal hernia is a condition that affects 1 in 50 pediatric patients. Let me save you some anxiety by taking you through the facts and process of treating a pediatric inguinal hernia.

What is an inguinal hernia?

Inguinal hernias occur when an opening in the groin area that usually closes after birth fails to close completely. As a result, parts of the intestines can protrude through the opening and usually appears as a bulge in the groin, especially when the child cries or strains (e.g. when your child has a bowel movement). Occasionally, this bulge may not be visible. Therefore, when you see your doctor, you are encouraged to bring in a photo of the bulge. Inguinal hernias in children are very common (2% of children in general), but they are more common in boys and premature babies.

What happens if the inguinal hernia isn’t treated?

If left alone, the protruding part of your child’s intestines can get stuck in the opening or another weak spot in the child’s abdominal wall. If not pushed back immediately, that part of the intestine can lose blood supply, leading to bowel obstruction, perforation or permanent dysfunction (in severe cases). A child with an inguinal hernia may have an irreducible groin mass (which may be tender), abdominal distension (bloated stomach), and episodes of vomiting. For boys, this dislocated bowel may also compromise the blood supply to the testis on the same side. If left for a prolonged period of time, the testis may shrink (atrophy). For girls, the hernia often contains an ovary. If left alone, the ovary may be starved of blood and eventually die.

When is surgery necessary?

I’ve worked in the U.K., Canada, and Australia. In these countries, hernias are surgically repaired as soon as possible. Premature babies with hernias are operated on before they are discharged from the hospital. This is because most stuck bowel cases occur in the first few months of life. In other countries including China, some surgeons choose to monitor the hernia for one year to see if the condition will resolve itself.

In my personal, professional medical opinion, I recommend operating on pediatric inguinal hernias sooner rather than later. Most inguinal hernias do not resolve spontaneously. My former colleague Dr. Jacob Langer, Division Head of Surgery at the Toronto SickKids Hospital, found that repairs done within two weeks decreases the child’s risk of stuck bowel by half of what it would be with a 30-day wait.

What happens in inguinal hernia surgery?

We close the opening that contains the protruding intestines and check the patient for a possible hernia on the other side as well (bilateral hernias occur in 10% of patients). If another hernia is present, we will recommend repairing them at the same time. I also check for other conditions that tend to occur with inguinal hernias, including un-descended testes. At Beijing United Family Hospital and Clinics (BJU), we use laparoscopic (minimally-invasive) surgical techniques that involve minimal scarring and faster recovery times.

What are the risks of inguinal hernia surgery?

Pediatric surgeons who are experienced and have regular practice can perform the procedure with very few complications. After the operation, temporary swelling may occur in the scrotum, especially after repairing a large hernia. However, the swelling disappears as the patient heals. Other complications may include wound infection, higher positioning of the testis, recurrence, and blood vessel damage on the rare occasion, according to the New Zealand Center. Patients usually get the surgery and go home on the same day. We recommend that the child comes in one week after the procedure for a general checkup.