Inguinal Hernia
What is an Inguinal Hernia?
An inguinal hernia occurs when a part of the abdominal contents, commonly a segment of the intestine, protrudes through a weak spot in the lower abdominal wall into the groin area. It is one of the most frequently encountered conditions requiring surgery in infants and children who are otherwise healthy. In male children, this type of hernia may extend down into the scrotum, resulting in a noticeable bulge on one side. In female patients, it often appears as a soft lump in the groin, and in many cases, the ovary may be the structure that has slipped out of place from the abdominal cavity. Early diagnosis and timely surgical intervention are important to prevent complications such as obstruction or strangulation of the herniated tissue.
Inguinal hernia: spot the signs in your child
As a parent, discovering an unusual swelling in your child’s groin or scrotum can naturally be concerning. This could be an inguinal hernia, a condition where abdominal tissue slips through a weakness in the muscle wall. Mr. C.K. Sinha, an experienced paediatric surgeon, highlights that these hernias often appear as a soft, sometimes intermittent bulge, especially when the child cries, coughs, or strains. While not always painful, ignoring it can lead to serious complications. If you notice such a lump, especially one that comes and goes, it’s important to seek medical evaluation promptly.
"Mr C. K. Sinha provided outstanding care to our 8-week-old son who was born with bilateral inguinal hernias. He was calm and friendly, and his professionalism and expertise left us feeling confident that our son was in safe hands. We cannot thank him enough for the care he provided, and for making two anxious parents feel very reassured. We would thoroughly recommend him!"
What causes an inguinal hernia?
Babies with an inguinal hernia are usually born with an open connection between the tummy and the groin, which has failed to disappear after birth. The hernia is usually becoming evident a few weeks or months after birth as the baby becomes stronger, and the pressure inside the abdomen increases.
Even toddler and older children may have the hernia connection present since birth, but they develop a visible and painful hernia only later in life when they become more active and during sports.
It is known that your child is at higher risk of having an inguinal hernia if you have a family history of inguinal hernias.
Symptoms of an inguinal hernia
In babies, the most common sign of an inguinal hernia is a visible bulge in the groin which can cause an asymmetry between the right and left side. Usually, the side affected by the hernia shows a lump which is soft and non-tender. In older children, a similar lump in the groin is present, and it gets bigger if your child is standing up or straining.
Around the age of four years, your child will be able to tell you if the inguinal hernia is associated with pain or discomfort.
To confirm the diagnosis of inguinal hernia, it is important to take a picture of the lump in the groin when it is clearly visible and to bring it to your appointment with Mr C. K. Sinha. This will help Mr C. K. Sinha to confirm the diagnosis and advise on the best management.
Inguinal hernias need to be repaired with a surgery as soon as possible to reduce the risks of complications, such as the intestine getting blocked or strangulated in the groin. If your child is complaining of severe groin or testicular pain persisting for more than half an hour, you should bring your child to the closest A&E to get checked.
Mr C. K. Sinha is usually available to review your child within 24–48 hours and this will be ok for all the non-urgent cases.
Treatment options for an inguinal hernia
After Mr C. K. Sinha has confirmed the diagnosis of inguinal hernia, he will discuss with you the best treatment option based on your child’s age and the risk of having a bilateral inguinal hernia or an associated umbilical hernia.
The two types of surgery available are the laparoscopic hernia repair (keyhole surgery) and the open hernia repair. For both techniques, unlike in adults, there is no need to use meshes or prosthesis, as the hernia is safely repaired with one or two stitches.
The laparoscopic hernia repair is based on a minimally invasive technique, which involves the surgeon operating via small incisions (3mm) made in the abdomen. Your child will be put to sleep by the best and most experienced neonatal and paediatric anaesthetist working in Mr C. K. Sinha’s team. Before the incisions are made, the abdomen is inflated with a special gas to make the internal organs easier to see. A tiny tube carrying a 3mm camera is then inserted through one incision, while small surgical tools (3mm) at the end of a fine stick are inserted through other incisions to repair the hernia. This laparoscopic hernia repair is preferred in babies or when a child has bilateral inguinal hernias or when there is an associated umbilical hernia. The surgery lasts about an hour.
The open hernia repair is based on a small incision in the groin to expose and fix the hernia sac with stitches. The general anaesthesia and the time of the operation are similar to the laparoscopic one. This technique is preferred for monolateral hernias in older children. In girls after the age of one, the open hernia repair has the advantage of having a tiny incision (8–10mm), which will not be visible in the long term.
Both these surgical techniques to fix inguinal hernias are performed as a day case without an overnight stay in the majority of cases. The recovery is usually fast and requires a few days at home and no physical activities for three weeks.
Mr C. K. Sinha will do his best to accommodate a date for the surgery within 1–2 weeks after the initial consultation to reduce the risk of complications.
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MR CK SHINA
Consultant Paediatric Urologist & Paediatric Surgeon