1  Groin or Inguinal Hernias

A paediatric inguinal hernia can appear / occur at any age, but the peak incidence is during infancy and early childhood with  80 to 90% occurring in boys. 

Some Statistics

About 3% to 5% of healthy, full-term babies may be born with an inguinal hernia and one third of hernias of infancy and childhood appear in the first 6 months of life.  In premature infants the incidence of inguinal hernia is substantially increased, up to 30%.  In just over 10% of cases, other members of the family have also had a hernia at birth or in infancy.

Right side hernias are commoner than left.  The figures are as follows:
 

Symptoms

A hernia in an infant or a child will be seen as a bulge or a swelling in the groin.  In boys the swelling might be seen in the scrotum.

In many cases the swelling may only be seen during crying or straining.  This may lead parents to assume that the crying is because of the hernia,  whereas it is more often the case that the hernia appears because the child is crying for some other reason.

Inguinal hernias in children are prone to get 'stuck', ie the lump does not go away when the child relaxes, and this is called incarceration.  Because incarceration is quite common most experts advise that groin / inguinal hernias should be repaired as soon is practicable after they are discovered / diagnosed.  However, an incarcerated or irreducible hernia (that does not reduce or 'go back in') should be seen by a doctor urgently.  In an acute situation, the child or infant should be admitted to hospital and given some pain relief and sedation.  Initial attempts are made by the doctors to gently negotiate the hernia back inside.

If the hernia does not go back, or the child is ill, the 'irreducible' hernia should be operated upon urgently as it may contain intestine that is in danger of strangulating.  Strangulation is extremely serious and must be avoided at all costs. If the hernia does go back without any emergency operation it should still be repaired (operated on) at an early stage.

The Operation

The surgery must be carried out under general anaesthetic. This may be carried out as a day case or the child may stay overnight. Even a technique that could be done under local anaesthesia (as we do routinely with adult patients at The British Hernia Centre) should be done using general anaesthesia with children. The main reason is to avoid subjecting a young person to what may seriously frighten them if they are awake.

A small incision is made in the groin and the hernia 'sac' is found.  In children /babies it is sufficient to remove the hernia sac. The hole in the abdominal muscle does not usually need to be repaired - ie does not need stitching or mesh. The 'hole' will close itself as the child grows.

The incision in the skin is usually closed with dissolving stitches.

2  Umbilical hernia

This is one of the most common paediatric surgical conditions affecting, perhaps, 1 in 5  (20%) of all children.

Umbilical hernias are more common in premature babies and children with Down's syndrome and there is a slight familial tendency.

They appear as a bulge at the umbilicus, (the navel) which can vary in size from that of a pea up to the size of a small plum. They are not usually painful and are much more obvious when the baby or child cries or strains.

What happens if they are not treated? ~ Do they need an operation?

There is a general agreement that most infantile umbilical hernias will eventually close spontaneously, though experts disagree over what period of time.  Probably 80 to 90% of umbilical hernias will have closed by the time the child is 3, but the larger ones may be present up to 11 years before finally closing. The time taken to close probably depends on the size of the hole / defect / opening with 95% of umbilical hernias less than 0.5 cm in diameter, closing by the age of 2 years. Umbilical hernias present after puberty will probably not close spontaneously.

In the case of infantile umbilical hernias, problems, particularly strangulation - where a portion of intestine becomes trapped in the hernia, rarely occur, so that surgery is rarely required. However the presence of pain in the hernia, particularly if associated with vomiting or constipation requires an urgent surgical opinion and possible operation.

3 Where to get treatment

The British Hernia Centre is happy to consider all cases of hernia.

However, unlike in the case of adult hernias - which are very demanding in terms of achieving completely reliable repair and which benefit greatly from hernia specialisation, paediatric hernias can be very successfully treated by any good paediatric surgeon.