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Hernias are extremely common in children. Unlike hernias in adults, most hernias in children are not caused by a weakness in the abdominal muscles but, rather, are due to congenital openings in the abdominal muscles that don’t close correctly prior to birth. Intestine, and other abdominal organs, can protrude through these openings so that parents and other caregivers may eventually see a “bulge” of tissue beneath the skin. Hernia repairs are the most common elective surgical procedures performed by general pediatric surgeons.
Some of the more common types of hernias seen in children are inguinal hernias, umbilical hernias and epigastric hernias. Inguinal hernias are typically found in the groin region near the scrotum in boys and next to the labia in girls. Umbilical hernias are found in the belly button. Epigastric hernias are usually mid-way between the belly button and the lowest part of the breast bone (sternum). Inguinal muscle strain (also called a “pulled groin muscle” by some and a “sports hernia” by others) is, technically, not a true hernia but may be a cause of significant pain, especially in athletes.
An inguinal hernia can develop if the inguinal canal does not close off completely after birth. As a baby boy matures during pregnancy, his testicles develop in the abdomen, and then move down into the scrotum through an area called the inguinal canal. After birth, the inguinal canal closes, preventing the testicles from moving back into the abdomen. If this area does not close off completely, a hernia can be caused if a loop of intestine moves into the inguinal canal through the weakened area of the lower abdominal wall. Girls can develop hernias in this area, also, because while they do not have testicles, they do have an inguinal canal.
When a woman is pregnant, she and her fetus are connected by the umbilical cord. It passes from the mother to the baby through a small opening in the abdominal muscles. After birth, this opening will generally close as the baby matures. However, these muscles sometimes do not grow together completely. When a small opening exists, a loop of intestine can enter and cause a hernia.
This is found in the belly button (umbilical ring) area, and parents usually don't notice until a few weeks later. With an umbilical hernia, the belly button bulges outward. It's most noticeable when the baby is straining, coughing or crying. In some cases, the pediatrician may be able to push gently on the bulge or swelling to help it reduce in size or go back into the abdomen. If it's not reducible, the loop of intestine protruding through a hernia may become stuck, causing a loss of the blood supply needed to keep the intestine healthy and functioning properly. In some cases, pediatric surgery may be necessary to make a surgical hernia repair.
Most umbilical hernias close up spontaneously, without surgery, during the first several years of life. However, some do not and ultimately require repair. Most surgeons recommend waiting until the child is roughly 3-5 years old, unless the child develops symptoms (typically pain in the belly button region), incarceration (intestine that is “stuck” in the bellybutton), or if the hole is large (one inch in diameter or greater). If in doubt, consultation with one of our pediatric surgeons in our clinic may be arranged.
Most epigastric hernias do not close spontaneously. Eventually, they may cause symptoms such as pain as children become more active (especially playing sports and doing other physical exertion). Most pediatric surgeons therefore recommend repair of these hernias.”
Roughly 10 percent of children who develop an inguinal hernia on one side of the groin will return with one on the other (contralateral) side at a later date. Children at highest risk for this are former premature babies (born before 37 weeks gestation) and children who develop their first hernias early in life (typically, boys in the first 1-2 years of life and girls in the first 4-5 years of life). Many parents want to prevent the need for a second surgical procedure, if at all possible. Since the late 1980s, some pediatric surgeons have used diagnostic laparoscopy to look to the other (contralateral) side, during a hernia repair operation, in order to decide if the child is going to develop another hernia (on the other side) in the future. The procedure typically adds about five minutes to the hernia repair operation but has an accuracy rate (to predict the development of a hernia on the other side) of over 99 percent. Whether or not laparoscopic hernia evaluation should be performed in your particular child can be discussed during your consultation visit with one of our pediatric surgeons.”
Depending on the type of hernia and the age/size of the child, your surgeon may recommend a laparoscopic approach to the hernia. The surgeon will typically make three small incisions and insert a laparoscope and several small instruments. The hernia (a small hole in the muscles of the abdominal wall) may be closed by placing sutures (stitches) internally, to close the hole. In rare cases, such as recurrent hernias and conditions that weaken the surrounding muscles, prosthetic mesh may be placed by the surgeon during the operation. These operations are typically performed as outpatient procedures so that children can go home within several hours of the procedure.
Learn What to Expect from Hernia Repair
The International Pediatric Endosurgery Group has published guidelines on the minimally invasive treatment of pediatric inguinal hernia surgery.
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