Hernia Repair

A hernia develops when an opening allows tissue or an organ from inside the abdomen to protrude outside its normal position.

In an inguinal hernia, the problem is usually related to a small channel between the abdomen and groin that remains open after birth.

A loop of intestine may pass through this opening, and other tissues may also enter the hernia depending on the child's sex and anatomy.

An umbilical hernia occurs when the muscles around the belly button do not close completely after birth, allowing a bulge to appear at the umbilicus, particularly when the child cries, coughs or strains.

Hernias in children differ from many adult hernias, and the surgical approach therefore also differs.

Inguinal Hernia:

An inguinal hernia usually appears as a bulge or swelling in the groin.

The swelling may come and go and often becomes more noticeable when the child cries, coughs or strains.

In boys, the hernia may extend into the scrotum. In girls, swelling may appear in the groin or labial area.

Once an inguinal hernia is diagnosed, surgical assessment and repair are generally recommended because the hernia does not close spontaneously and abdominal contents can become incarcerated.

Umbilical Hernia:

An umbilical hernia appears as a bulge at the belly button and may become more prominent when the child cries or strains.

Most umbilical hernias cause no problems, and many close naturally during the first several years of life.

An uncomplicated umbilical hernia can often be observed. Surgery may be considered if it remains open as the child gets older or if symptoms or complications develop.

Most hernias in children are diagnosed by physical examination.

Parents may notice:

• A lump or bulge in the groin.
• Swelling extending into the scrotum in some boys.
• A bulge at the belly button.
• Increased prominence when the child cries, coughs or strains.
• A bulge that becomes smaller or disappears when the child is relaxed or lying down.

A hernia may not be visible all the time. It can therefore be useful to tell the doctor when the swelling appears and what it looks like.

If the bulge does not appear during the appointment, a clear photograph taken when it is visible may sometimes help the assessment.

Imaging is not required in every case. The doctor may request imaging when the diagnosis is uncertain or another cause of swelling needs to be considered.

When is a Hernia an Emergency?

Hernia contents can sometimes become trapped and cannot return to the abdomen. This is called incarceration.

If the blood supply to the trapped tissue becomes compromised, strangulation may occur. This requires urgent medical assessment and treatment.

Urgent medical attention is needed if the child develops:

• A painful or firm bulge that no longer disappears as it previously did.
• Severe pain or unusual persistent crying.
• Repeated vomiting.
• Abdominal swelling.
• Redness or abnormal discoloration over the hernia.
• Significant tenderness over the swelling.
• A child who appears increasingly unwell or refuses feeds.

A painful or firm hernia should not be forcefully pushed back into the abdomen at home.

Treatment:

Treatment depends on the type of hernia.

Inguinal Hernia:

Surgical repair is the standard treatment for an inguinal hernia in children.

During surgery, the hernia contents are returned to the abdomen and the opening through which they passed is closed.

Repair may be performed through a small open groin incision or laparoscopically in selected cases. The surgeon determines the most appropriate approach for each child.

Umbilical Hernia:

Most uncomplicated umbilical hernias can be observed during the early years because many close naturally.

Surgery may be considered when the hernia remains open beyond the age when spontaneous closure is expected, is unusually large, produces symptoms or develops a complication.

During umbilical hernia repair, the contents are returned to the abdomen and the opening in the abdominal wall is closed with sutures.

Mesh is generally not required for a straightforward umbilical hernia repair in children.

Before hernia repair, the child is assessed to confirm the type and location of the hernia and identify any associated medical conditions.

Parents should follow the medical team's instructions regarding fasting and medications before anesthesia.

The surgeon should be informed if the child:

• Takes regular medication.
• Has a known bleeding problem.
• Has allergies to medications.
• Develops fever, infection or a new illness before surgery.
• Was born prematurely or has another medical condition that may affect anesthesia or postoperative observation.

Before surgery, parents can discuss:

• The type of hernia.
• The proposed surgical approach.
• Anesthesia.
• Wound care.
• Activity after surgery.
• Follow-up arrangements.

After hernia repair, parents receive instructions about wound care, pain relief and appropriate activity.

Some discomfort or mild swelling around the surgical area may occur during the early recovery period.

Medication should be given according to the medical team's instructions, and wound-care and bathing guidance should be followed.

Return to normal activity varies according to the child's age, the type of hernia and the surgical approach, so the treating surgeon's instructions should be followed.

The medical team should be contacted if the child develops:

• Persistent bleeding from the wound.
• Wound discharge.
• Increasing redness or swelling.
• A significant fever.
• Repeated vomiting.
• Severe or increasing pain despite prescribed treatment.
• Reduced urination or difficulty urinating.
• A new or recurrent bulge at the repair site.

Follow-up helps confirm appropriate wound healing and assess the surgical repair.