Paediatrics: Inguinal hernias

Inguinal hernias

Groin hernias in children are almost invariably indirect inguinal hernias. Femoral hernias are rare in children. Inguinal hernias have the following characteristics.

•   More common in boys.

•   More common on the right side, due to later descent of right testis.

•   15% hernias are bilateral.

•   Symptoms are rare.

Clinical care

•   A reducible swelling in the groin, often extending into the scrotum (Fig. 23.16).

•   Surgical herniotomy. Infants should be repaired within a few weeks of diagnosis because the risk of incarceration is high. The risk of incarceration lessens after the age of 1yr.

Incarcerated hernia

•   Incarceration results in an intestinal obstruction.

•   There is a 30% risk of testicular infarction due to pressure on the gonadal vessels.

•   Treatment of an irreducible inguinal hernia comprises resuscitation of the child and then reduction of the hernia by taxis (i.e. gentle, but sustained pressure is applied to the sac to reduce the contents).

•   Most hernias can be reduced safely, although it may be necessary to give the baby morphine first. If the hernia cannot be reduced, emergency surgical exploration is necessary (but this is rare). The use of gallows traction to reduce a hernia is obsolete.

•   Provided the hernia is reduced a herniotomy should be performed after 24–48hr to allow for any oedema to settle.