Pediatric Hernias &

What is an inguinoscrotal swelling?

Any swelling in the groin of a child is described as an inguino scrotal swelling. In boys the swelling might start in the groin and extend upto the scrotum. In girls the swellings are usually limited to the groin but rarely can extend upto the labia. They can be present only on one side or might be present on both sides.
The most common causes of pediatric groin swellings are hernias or hydroceles. The other less common causes might be Undescended testes and swollen lymph nodes.

What are pediatric hernias?

The protrusion of intra-abdominal contents through any defect in the abdominal wall is known as a hernia. In children of both sexes the most common site of hernia is the groin. The other sites being umbilical, paraumbilical, epigastric and lumbar. During the fetal life there is a normal protrusion of the lining of the abdomen through the deep ring in the groin, known as the processus vaginalis. This opening should normally close after birth. In some children this remains open and manifests as a groin hernia.

What is a pediatric hydrocele?

It is a condition when there is a collection of fluid around the testis of the child. The testis appears much bigger than the other side. This is usually due to a tiny opening in the deep ring though which only fluid can come down. At times the testis might be normal but there might be a fluid filled swelling in the groin. This is called an encysted hydrocele of the cord.

What are the problems that are caused for my child due to hernias or hydroceles?

Hernias and hydroceles are usually painless swellings that do not cause any form of discomfort for the child. At times however in hernias the contents might get stuck at the neck. This is known as an incarcerated hernia. Incarcerated hernias can lead to intestinal obstruction, loss of blood flow to the trapped organ and gangrene of the trapped organ. This is an emergency and needs to be managed immediately.
Hydroceles are relatively benign and may be observed till the child is older. They however do increase the chances of injury to the area especially in a toddler. It is very important to differentiate a hydrocele from an hernia.

When should I meet a doctor?

It is advisable to meet a pediatric surgeon as soon as a swelling is discovered in a child. This enables proper diagnosis and plan for treatment of the swelling.
In case your child has any of the following then you should be concerned.
- Painful and angry looking swelling in the groin.
- Swelling appears much bigger than usual.
- Persistent inconsolable crying in the child.
- The swelling does not disappear on its own.
- Abdominal distention with repeated vomiting.

If any of the above or if there is any doubt then to consult the emergency for immediate attention by a pediatric surgeon.

How are pediatric hernias and hydroceles treated?

As explained above the cause of hernias and hydroceles is the failure of closure of the deep ring. Therefore medications are not needed for the treatment of the same. A small surgery is done by putting a small cut on the deep ring and tying of the patent processus vaginalis. It is a day care procedure which means that the child is admitted on the day of the surgery and is discharged home on the same day.
The child does complain of a little pain in the operated area that is managed with pain killers. The child is sent home with a waterproof dressing that is removed by the doctor later during the follow up visit. No special care of the child is needed after this procedure.

Can the surgery be done laparoscopically?

Yes, Herniotomy can be done laparoscopically especially if it is present on both sides. The relative merits and demerits of the same can be discussed with the pediatric surgeon and the appropriate approach is chosen before the procedure

When is the right time for getting my child operated ?

Pediatric hernias should be operated at diagnosis as there is risk of incarceration. The pediatric surgeons usually schedule the surgery in the next convenient slot. In case of hydrocele one may wait till the child is 2 years old or later. In case of other hernias the decision is based on the child and the specific type of the hernia.

What are the long term implications of the hernia surgery for my child?

Hernia surgery is a minor procedure and is associated with no long term complications for the child. Some children might have a faint scar that is visible upto adulthood but the same is usually well hidden in the underwear.

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