What is an inguinal hernia?
A hernia is an abnormal protrusion through an internal ‘hole’ or defect in the body. A hernia usually appears as a ‘lump’ or ‘bulge’.
The term ‘inguinal’ refers to the inguinal region in the groin where the hernia occurs.
Sometimes the hernia is confined to the inguinal region; sometimes it extends into the scrotum (the so-called “inguino-scrotal hernia”).
90% of inguinal hernias occur in boys.
The abnormal defect consists of a ‘sac’ that extends from the abdominal cavity (where the bowel, or ‘guts’, are) into the inguinal region and sometimes right down into the scrotum. Imagine a sausage-shaped party balloon that has not yet been blown up. This is what a hernia sac is like. When ‘guts’ enter the sac it is like blowing up the balloon and this forms a bulge.
Is an inguinal hernia dangerous?
Yes. Gut in the hernia can become stuck out (‘irreducible’) and can obstruct or strangulate.
Obstruction means the bowel in the hernia is blocked causing abdominal (or ‘tummy’) distension and vomiting.
Strangulation mean the bowel is squeezed so tightly that its blood supply is cut off and it dies and becomes gangrenous.
Obstruction and strangulation occur if the hernia is stuck out for a long time. If this happens, it can also squeeze the blood vessels going to the testicle and cause testicular damage.
These problems are much more common in young babies than in older children.
How do you treat an inguinal hernia?
The only effective treatment is surgery.
The hernia will not resolve by itself.
Surgery is recommended for all children with an inguinal hernia. The operation is more urgent in young babies than in older children.
How is surgery performed?
Usually the operation can be done as a day case except in very young or premature babies who will have to stay in hospital for a night. In day case surgery, you can take your child home a few hours after the operation finishes.
Your child will be under a general anaesthetic (fully asleep).
Local anaesthetic is also used to reduce the amount of pain felt after the operation.
An incision (cut) about 3 to 5 cm long is made in the inguinal skin crease.
The hernia sac is carefully separated from the tubes going down to the testis (the blood vessels and the ‘vas’). The sac is then tied off and cut. This cures the hernia. The wound is sewn up with dissolving stitches that run under the skin. In girls, the operation is easier because the delicate tube, the fallopian tube, is safely in the abdomen.
What are the risks of the operation?
All operations carry risks. The operation is still worth doing because the risk of complications from the hernia (see above) is much greater than the risk of the operation. To minimise the risk a paediatric surgeon and an anaesthetist who specialises in children’s surgery will perform the operation.
The risk of the anaesthetic is extremely small in healthy babies and children, and the anaesthetist will discuss this with you.
The main surgical risks are:
- Infection in the wound
- Bruising or bleeding (common to have a small amount but very rare to have a lot of bleeding)
- Recurrent hernia
- Testicular atrophy, where the testicle shrinks because the blood vessels have been damaged (rare, ~1% of elective operations, but more common if the hernia had been stuck out for a long time)
- Injury to the vas
- Undescended testis, where the testis is caught up in scar tissue above the scrotum
These complications are rare.
The proviso to this is after strangulation of the hernia, where testicular atrophy is more common because of pressure on the blood vessels from the strangulating hernia.
What are the benefits of surgery?
The hernia is cured. The scar usually heals up very nicely after this operation.
What happens after the operation?
Your child will wake up in the post-anaesthetic care unit. Specialist nurses will care for your child and provide any extra pain relief that is needed.
You will be in the hospital for approximately 2 hours after the operation.
