In this section
A hernia is a lump or protrusion of an organ
(usually the small bowel or fatty material) through a weakness or
opening in the muscle wall of the abdomen (tummy). It is usually seen as a
bulge under the skin.
An inguinal hernia is a hernia that occurs in
the groin region. In boys, an inguinal hernia may extend into the scrotum. It
affects one to five per cent of full-term babies. It is more common in boys and in premature babies (seven to 30 per cent). Boys are four to eight times more likely
than girls to have an inguinal hernia.
In boys, the testes are initially located in
the abdomen. Around the seventh month of pregnancy, the
testes travel down into the scrotum through a passage called the
inguinal canal. The canal begins to close before
birth and is normally completely fused or shut by the end of the first
year of life. If this canal does not close completely and the
muscles in the wall of the abdomen do not cover the opening well
enough, a hernia may develop.
Though less likely, girls can also develop an
inguinal hernia. They have a similar but smaller passage.
There is nothing you did or did not do that
caused the hernia to develop. The opening in the abdominal wall is
present from birth and a hernia may develop at any time. They are usually picked up in newborns or within the first year of life. However, they may go unnoticed for many years. There is no routine
treatment of newborns that will prevent the development of a hernia.
Hernias are slightly more common on the right
side, but can occur on the left or on both sides.
Hernias are more noticeable during, but they
are not caused by, crying or straining.
Symptoms may include:
In a simple hernia, the bowel and fatty
tissue are able to move freely in and out of the defect. This is described as being reducible. If part of the bowel
becomes trapped and cannot return to the abdomen, it is at risk of
having its blood supply cut off. This is then irreducible and is described as an incarcerated hernia.
The symptoms of an incarcerated inguinal
hernia can include:
Your doctor can usually make the diagnosis
based on your description and his or her examination of your child's groin on
both sides. The examination may include feeling the hernia and
trying to reduce it. If the hernia is not visible at the time of
the visit, your doctor may try to bring it out by pressing lightly
on your child's abdomen.
No further tests are usually necessary to diagnose a
Once the diagnosis of a hernia is made,
surgical repair (a herniotomy) will be performed.
Yes. Surgery is necessary in all cases, even
if the hernia is not yet incarcerated. Herniotomy will prevent the hernia
from coming back and potentially becoming trapped. Recurrence rates
are less than one per cent in an uncomplicated hernia. There is no non-surgical treatment for hernia. If the hernia is detected and
corrected early, aside from a small scar there should be no long
Even a simple hernia carries a
risk because it can become incarcerated. Once a hernia is
incarcerated, if it is not treated fairly quickly it can lead to
immediate life-threatening events including bowel obstruction,
bowel perforation and even death.
Long term complications involving the
reproductive organs can occur from delayed or non-treatment. These
include the risk that the testes in the male and ovaries in the female can have the blood supply cut off, and therefore waste
If your child has a hernia on one side only,
there is a small possibility of developing a hernia on the other
side. Your surgeon will discuss with you the pros and cons of
surgery on the unaffected side to prevent future hernia development.
There is no right or wrong approach. You can
discuss this with your child's surgeon and make decisions based on
your preferences and what is common practice at the hospital you are attending.
It varies depending on the age of your child
and the severity of the hernia. The younger your child is, the
earlier the hernia should be repaired. In general, an uncomplicated hernia
should be fixed as soon as is practical. If the hernia is
incarcerated, the need for an operation is more urgent.
It will vary depending on
the age of your child, the nature of the anaesthetic to be used and
whether one or both sides of the groin will be operated on. Your
child will usually be away from you for around one to two
Hernia repair is usually done
under anaesthesia. This will be performed by a specialist
paediatric anaesthetist. Anaesthetic can be either general (where
your child will be asleep), or spinal (where your child will be completely numb from the chest down during the operation). The decision about which type of anaesthetic is used depends on each
individual and will be discussed with you.
can also be given either before surgery or at the end during
wound closure, to help control post operation pain.
The operation involves a
small cut (one to two centimetres long) in the groin at the natural skin crease. The
contents of the hernia sac are emptied back into the abdomen and
the sac is tied off. The wound is closed with dissolvable sutures (stitches) that will not need to be removed.
Mesh coverings used in adult
hernia repair are generally not required in children.
All operation wounds heal with a scar.
However, because the cut is very small (one to two centimetres) and given its
position in the lap crease, it will gradually become barely
In any surgical procedure,
there are risks of side-effects from the anaesthetic, wound infection
and bleeding. The risk of these happening is less than one in one hundred. Complications specific to hernia repair are quite rare.
They may include:
Your child will need to fast (not have anything to eat or drink) before surgery. The timing and duration of fasting will vary,
depending on whether it is a morning or afternoon procedure. If
your child is under six months of age, guidelines will be
different if breastfeeding or formula feeding.
You will be sent a letter in the
mail a few days before the surgery with the
fasting instructions. In the event of an incarceration, the surgery may need to be undertaken urgently. The anaesthetist will take
extra measures to compensate for lack of fasting if this happens.
Hernia repair is usually a day
procedure, and your child should be able to go home afterwards. In some
circumstances, your child may need to stay overnight in the
hospital for observation. This might happen because:
After your child's surgery, you will be given a number
to call and some post-operative care instructions. In general, contact your child's surgeon or the hospital if:
Developed by the RCH Dept of Paediatric
Urology. First published April, 2009. Updated November