Inguinal Hernia

In young children, an inguinal hernia is considered to be due to the normal opening in the abdomen not closing after birth, rather than a development that occurs later in life due to stressing the lower abdominal wall.

An inguinal hernia may develop on either side and can occur on both sides.

During development, testicles first form in the abdomen below where the kidneys eventually reside. When the fetus is developing, the testicle will begin descending from this area into the scrotum along with a sac-like portion of the abdominal lining. In adulthood, this sac will still surround the testicle, but the abdominal connection will generally close after the testes descent.

A hernia develops when this abdominal wall closure does not occur, resulting in the extension of the sac from the abdomen into the wall of the abdomen and into the inguinal canal. This can extend into the scrotum and the sac around the testicle.

An inguinal hernia can have fluid or abdominal cavity contents within the sac. Premature infants generally are at higher risk for this process and are more likely to have abdominal contents such as bowel or omentum in the hernia sac if present.

Symptoms of an inguinal hernia can include:

• A bulge appearing on the side of the pubic bone, becoming more evident when the patient is upright or cries
• An aching or burning sensation at the bulge
• Discomfort or pain emanating from the groin, particularly when coughing or bending over
• A dragging or heavy sensation in the groin
• Pain and swelling around the child’s testicles

Certain factors lead to a higher risk for the development of inguinal hernias among children, such as:

• Prematurity or a family history of hernias
• Cystic fibrosis or undescended testicles
• Developmental hip dysplasia

Girls also have an inguinal canal and can also develop inguinal hernias. Sometimes, in boys and girls, the intestinal loop extruding through the hernia can be prevented from returning to the abdominal cavity, and this is called an incarcerated hernia, which requires emergent treatment.

An inguinal hernia will not go away on its own. Hernia repair surgery will take about one hour to perform. The pediatric surgeon or urologist can close the hernia sac opening using laparoscopic methods or through a tiny incision in the groin. Most of the incisions are closed with dissolving sutures generally placed under the skin and will not need to be removed.