Guide for families of children with an inguinal hernia
What is an inguinal hernia?
The testicles formed in the baby's abdomen during the intrauterine period pass through the inguinal canal and descend into the scrotum before birth. During this descent, they drag along the peritoneum called the processus vaginalis. Normally, this membrane closes and disappears after the testicles descend into the scrotum. Inguinal hernias occur when the processus vaginalis does not close and remains fully or partially open. Although it is seen at a rate of 0.8-4.4% in normal children, it may increase up to 16-25% in preterm births. It is 8-9 times more common in boys than girls. They are usually insignificant and manifest as a painless swelling in the groin area or scrotum. The appearance of this swelling from time to time and its disappearance by pressing on it or lying on the back is sufficient for the diagnosis of hernia.
What are the surgical requirements?
Treatment of inguinal hernia in children is technically a quick and easy procedure. However, delaying the treatment for various reasons can lead to hernia suffocation, which is the most important and dangerous complication of hernia, and when the hernia is diagnosed, it should be corrected with surgery as soon as possible. A strangulated hernia is said if the intestine that normally enters and exits the sac gets stuck in the sac for any reason and cannot return to the abdomen. Once the event starts, it progresses rapidly, the compression of the organ in the sac leads to edema, which further increases the compression. First, the venous blood circulation of the organ, and then the arterial blood circulation is disturbed. Gangrene, necrosis, and perforation can occur within hours. In this case, the sac of the testicles becomes sensitive, red, and tense. The baby is extremely restless and cries constantly. Vomiting, diarrhea, or constipation may occur. This situation requires urgent intervention.
How is the preparation for the surgery done?
The surgery is performed under general anesthesia. For this reason, about 3-4 days before the operation, the necessary analyzes and examinations are requested for anesthesia approval. If these tests are evaluated by the anesthesiologist and there is no problem, the oral intake of the child is stopped at least 6 hours before the surgery.
How is the surgical procedure performed?
In the operation, the hernia sac is separated by entering through an incision of approximately 2-3 cm from the inguinal region. This technique is called high binding. The success rate in these is at the level of 99%. However, in strangulated hernias taken as an emergency, this gap decreases and the risk of complications increases.
How is follow-up done in the early postoperative period?
After the surgery, the child is not allowed to eat or drink anything until the bowel sounds begin or until the gas is produced (approximately 4-6 hours). During this period, intravenous fluid support is given. He is discharged in the evening or the next morning on the same day. After discharge, daily dressing is applied for 1 week and prescribed antibiotics and painkillers are used. The stitches will dissolve on their own within 10 days or if non-melting stitches are used, the stitches should be removed one week after the surgery. Bathing is not recommended for a week.
How is follow-up done in the late postoperative period?
Again, the child is checked 1 week and 1 month after the operation. It is necessary to consult a doctor in cases such as swelling, redness, fever, general condition disorder at the wound site.
What are the complications of this surgery?
Allergic, heart and lung problems due to anesthesia and anesthesia during and after the operation may occur, albeit at a very low rate. Complications related to the wound site after surgery (opening of the wound, infection), the need for reoperation due to bleeding into the scrotum after surgery, injury to the intestinal segments in the hernia sac, and damage to the testis may develop with a low probability. Inguinal hernia can recur at very low rates after surgery.