Inguinal Hernia

According to the American College of Surgeons, 5 of 100 full-term and 30 of 100 premature infants will get an inguinal hernia. It occurs ten times more frequently in males.

What is an inguinal hernia?

During development of the fetus there is an open canal (inguinal canal) that connects the abdomen with the scrotum in males and the labia in females.  Before birth this canal is supposed to close.  However, it often stays open and allows intra-abdominal organs such as the bowel to exit the abdominal cavity via the open canal. This is an inguinal hernia and occurs in the groin region in children.

What are causes of inguinal hernias?

In adults inguinal hernias are thought to be caused by strain, like lifting something heavy. This results in the abdominal wall muscles becoming weak, leading to a hernia. These hernias are considered acquired.  On the other hand, pediatric hernias are from a failure of closing of the inguinal canal as explained above and are considered developmental or congenital (present from birth).

Inguinal hernias are more common in premature babies.  Other factors that may put a child at greater risk of developing inguinal hernias include boys with undescended testicles, babies or children with a family history of hernias, or babies or children with cystic fibrosis.  Urethra abnormalities or developmental hip dysplasia can also be a factor.

What are symptoms of inguinal hernias?

If the hernia is large enough, symptoms can include swelling in or a physical bulge protruding from either side of the groin area.  The bulge may be more noticeable when a child cries, coughs or stands.  Similarly, the bulge may disappear when laying down.

Diagnosis of inguinal hernias

Diagnosing an inguinal hernia is generally done as a physical examination by a physician to determine if the hernia can be pushed back into abdominal cavity or not (reducible). 

What are treatments?

Inguinal hernia repair is one of the most common pediatric operations performed and is an outpatient procedure in an otherwise healthy full-term infant or child. Surgery is always recommended due to the high risk of a child’s intestines getting caught in the hernia opening, which can strangulate the hernia and decrease blood supply to the intestines.

The two most common methods of repair include:

  • Open hernia repair
    An open hernia repair involves a one to two-inch incision being made over the site and the hernia is then repaired by suturing the muscle closed.
  • Laparoscopic hernia repair
    A laparoscopic repair involves placing small ports through punctures or small, half-inch incisions in the abdomen. For children, this is often done through the bellybutton. Surgical tools and a 5mm camera with a light are placed into the ports to suture the open canal closed. Like in any laparoscopic operation, carbon dioxide gas is used to inflate the abdomen to make space for operating. The internal organs and other important vessels are easier to see, which may cause less trauma and lead to a quicker recovery time.

The next step

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