Surgical Aspects of Hernias in Infants and Children

The health and development of children is particularly important for parents to be aware of the most common childhood hernias, their formation, and treatment. The various types of hernias and the underlying causes can differ, and while many cases do not require urgent intervention, there are those that can lead to more serious problems if not treated in a timely manner.

The medical literature is continuously evolving, and new research helps to understand the nature of hernias, their symptoms, and the best treatment methods. Parents should pay attention to their child’s condition, and if they notice any suspicious signs, it is important to consult a specialist. Treatment for hernias may often require surgical intervention, but there are cases where waiting is the best solution.

Umbilical hernia, inguinal hernia, and hydrocele are among the most common childhood hernias, and each case requires a different approach. Below, we will provide a detailed overview of these hernias, their symptoms, and their treatment options.

Umbilical Hernia – Hernia Umbilicalis

An umbilical hernia is a congenital condition among children that develops during fetal development. The vessels that supply nutrients to the baby through the umbilical cord can create a defect in the abdominal wall in this area after birth. Many experience a bulge around the navel, which may be a sign of an umbilical hernia. This hernia is usually painless and does not affect the child’s daily life, as it does not cause problems during feeding or physical activity.

The size of an umbilical hernia can vary, ranging from a few millimeters to two or three centimeters. In most cases, the hernia heals spontaneously, and parents do not need to think about immediate medical intervention. According to literature, the ideal time for surgical intervention is generally around the age of 4-5, provided the hernia does not close spontaneously.

During surgery, a small incision is made in the lower part of the umbilical ring, allowing for the treatment of the hernia. The defect in the abdominal wall is closed with absorbable sutures, minimizing the need for skin stitches and eliminating the need for suture removal. The procedure is performed as an outpatient surgery, and the aesthetic result is favorable for the child.

It is important to note that skin adhesion over the umbilical hernia, which is sometimes common among infants, does not promote healing and can even lead to serious skin problems. Those hernias that do not close by the age of five can be treated surgically.

Inguinal Hernia – Hernia Inguinalis

An inguinal hernia is a condition where organs such as the intestine or peritoneum exit the abdominal cavity through the inguinal canal in the lower abdominal wall. The hernia content is located in a sac that surrounds the protruding organ. An inguinal hernia often presents as a swelling in the groin area, occurring in both boys and girls. In boys, it can extend to the scrotum and is more common in premature infants.

An inguinal hernia typically does not cause pain for the child, but it is important for parents to monitor for symptoms. It is possible for the intestine or other organ to become trapped in the hernia sac, leading to severe pain and intestinal damage. If an inguinal hernia is detected, it is important to consult a pediatric surgeon and avoid attempting to push the hernia content back without professional guidance.

Surgery for an inguinal hernia can be either classic or laparoscopic. In classic surgery, a small incision is made in the area below the bikini line, after which the hernia is removed and the abdominal opening is closed. In the laparoscopic method, a camera is inserted through the umbilicus, and the abdominal cavity is inflated to allow the surgeon to see the surgical area. The recovery period is similar for both procedures, and bed rest usually requires a few days.

After the operation, parents do not notice an aesthetic difference between the two techniques, so the choice depends on the surgeon’s preferences. Both procedures can be performed as outpatient surgeries, which further enhances favorable treatment options for children.

Hydrocele – Hydrocele Testis

Hydrocele in boys refers to fluid accumulation between the layers of the tunica vaginalis, which enters the scrotum through the inguinal canal. Parents often notice that their child’s scrotum is swollen, especially during bathing, but the swelling is painless. This swelling may decrease during the day or even completely resolve, as the movement of infants and the effects of gravity can allow the fluid to return to the abdominal cavity.

Hydrocele most commonly presents as communicating hydrocele, but reactive hydrocele can also occur as a consequence of various diseases. In such cases, increased fluid production in the tunica vaginalis causes the swelling. However, in cases of testicular swelling, immediate medical assistance is necessary, as this can be a painful condition.

If the diagnosis is hydrocele, surgical intervention is not urgent. In most cases, the fluid production resolves on its own, so it is expected that the problem will resolve by the age of 1-2 years. If the open canal is causing the fluid, surgery may be inevitable, but often it is sufficient to wait for spontaneous closure. The surgical process is similar to that of inguinal hernia surgery, and in both cases, potential risks and recovery times must be considered.

For the health of children, it is important for parents to be aware of the symptoms and treatment options for various hernias. Proper medical assistance and attentive observation are key to timely recognition and treatment of problems.