An explanation of Inguinal Hernia and treatment options.

Inguinal Hernia

An Inguinal Hernia is a lump in the groin, which is caused by a part of the bowel, or other contents of the abdomen, protruding through an opening in the lining of the abdomen, near to the groin.

In children, this opening which occurs normally in the developing foetus, should have closed over before birth. However, in approximately 5% of boys and 1% of girls, it remains open, even after birth.

Inguinal hernias occur more commonly in boys, as the opening is intimately associated with the normal descent of the testicle. It is more common on the right side and in approximately 15% of cases, it will occur on both sides.

An inguinal hernia will usually present during the first year of life, but may present at any stage during childhood. It usually presents as a lump in the groin which comes and goes. If a child becomes distressed for other reasons, the hernia may become more prominent.

What if the Inguinal Hernia is not treated?

In children under the age of 1 year, there is a strong chance that the hernia will become stuck. If this happens, the child will be in pain, and the protruding bowel is at risk of becoming damaged. In boys, there is also a risk of damage to the blood supply of the testicle. Sometimes the hernia may extend all the way down into the scrotum. In girls, the ovary may protrude as part of the hernia and may be wrongly diagnosed as an enlarged lymph gland in the groin. Inguinal hernias may also present with a bowel obstruction, which can be recognised by swelling of the abdomen, bile stained vomiting and the absence of bowel actions.

When to Operate?

Any child under the age of 1 year who has a lump in the groin should be reviewed urgently by a Paediatric Surgeon. As the risk of hernias becoming stuck and causing problems is less after 1 year of age, the situation is less urgent but nevertheless, the child should be reviewed by a Paediatric Surgeon.

When is an operation necessary?

Inguinal hernias do not go away of their own accord and they will require an operation to repair them. Children under the age of 1 year require an operation as soon as possible but in children over 1 year of age the urgency for operation is of course less. Occasionally, if the Paediatric Surgeon is unable to reduce the hernia back into the abdomen when the child is initially seen, an emergency operation may be required.

What are the results following operation?

Once the hernia has been repaired, there is less than 1% chance of the hernia recurring. If there has been no damage to the bowel, or the blood supply to either the testicle or ovary, the prognosis is excellent.