Inguinal Hernia and Hydrocele
DEFINITION
Inguinal hernia is a condition where there is a gap in the muscles of the abdominal wall in the groin that allows abdominal organs such as the intestine to bulge through. This area is referred to as the inguinal canal.
The inguinal canal in boys also contains the testicular cord, which contains the blood vessels and sperm tube for the testicle. In girls, the inguinal canal contains the round ligament, which helps to support and suspend the uterus.
Hydroceles are a pocket of fluid around the testicle, or the testicular cord. They can be described as encysted (which is like a bubble of trapped fluid), non-communicating (meaning the fluid around the testicle can not be squeezed out of the scrotum), and communicating (where the fluid can be squeezed beck in to the abdomen, which means it is a bit like an inguinal hernia, only smaller).
Between 1 and 5% of boys born at full term will develop an inguinal hernia. It is less common in girls, affecting 0.3-1%. It is more common in premature babies. It is most common on the right hand side, and a term baby boys who has one inguinal hernia, also has a 7% chance of also having a hernia on the opposite side. An inguinal hernia will not resolve on it’s own and requires surgical repair.
Most inguinal hernias will be intermittent, and will come and go spontaneously without causing pain or distress.
A small number will get ‘stuck’ and this can be an emergency if the organ inside the hernia gets squeezed and loses it’s supply of blood. This is uncommon, but is more likely to happen if your child is a newborn, and especially if they are premature. In this situation, the hernia/lump will usually be hard, painful to touch, and the child will be distressed and may vomit. If this happens your child needs to be taken to an emergency department immediately.
Hydroceles affect up to 5% of boys. They may be born with it, or may develop hydroceles in the first few months and years of life. Many hydroceles will resolve on their own without surgery.
GOALS OF CARE
Correctly diagnose the hernia type and location
Close the defect or hole so the organs cannot herniate through
Avoid damage to other organs and the testicular cord
Bonus: Identify if there is a hernia in the inguinal canal on the other side.
OUTCOMES
Inguinal hernia repair is one of the most common operations that a paediatric surgeon performs, and the outcomes are universally excellent.
All operations have a 1-2% risk of pain, bruising, and minor wound infection.
The main risks specific to hernia repair are recurrence of the hernia, damage to the vas deferens (sperm tube) or testicular blood vessels, testicular atrophy (rare) and acquired undescended testis (1 in 2000).
Hydroceles that present in infancy should be assessed by a specialist. If they are ‘non-communicating’ and not causing distress, then it is safe to monitor as most will resolve by the time your son is 2 years old.
OUR APPROACH
For the correction of inguinal hernia, Dr Rob has extensive training in both the classic open approach, which involves one medium sized incision in the groin, and the laparoscopic, or key-hole operation, which is 2 or 3 very small incisions on the abdomen. There is debate amongst paediatric surgeons as to which procedure is best, and as Dr Rob is trained in both methods, he offers a tailored approach to each of his patients. Dr Rob will recommend a key-hole operation in most cases but will discuss the pros and cons in your appointment.
If your child has a hydrocele that requires surgery, Dr Rob will address this via a single groin incision, similar to the open approach in the inguinal hernia repair procedure. This is the gold standard and standard practice world wide.
POST OPERATIVE RECOVERY AND CARE
Open and keyhole hernia repairs are a day procedure, unless your child is very young, or was born with significant prematurity. You will get to take your child home in the afternoon on the same day if they are feeding well and not in significant pain.
The incision/s will be closed with hidden dissolving stitches and covered with glue. You will be able to put your child in a bath or shower the very next day, the glue will slowly come off on it’s own and the stitches will disappear.
You should give your child some panadol and nurofen as required for a day or two, but your child should also recover and be back to their usual self within a couple of days.
It is recommended to avoid swimming in pools, oceans, rivers and lakes for 2-3 weeks after surgery, and older children may need to have a graduated return to sports after 2 weeks for key hole surgery, and up to 4 weeks for the open operation.
Dr Rob will see you in clinic 1 week after surgery to ensure your child is having the expected recovery.