Inguinal or umbilical hernias, which develop in many children who have good health as well, can be treated through outpatient surgery procedures.
Hernia, which can, in the simplest terms, be described as the condition in which an internal organ exits through a weak spot in the body area where it resides, is very common. The condition causes pain and a decrease in the life quality for adults and occurs mostly in the form inguinal or umbilical herniation in children. Why, then, do children develop hernias? How does the treatment process proceed? Is there any chance for it to recur? We have complied the answers to all these and similar questions on pediatric hernias after consulting Professor Selim Aksöyek, a pediatric surgeon at Acıbadem Kozyatağı Hospital.
What are the types of hernias that occur most frequently in children?
Herniation occurs when organs that are located in the abdomen protrude outside from a weak spot in the abdominal wall. The hernia types that are encountered most frequently during childhood are inguinal hernia, umbilical hernia and epigastric hernia, which develop in the slightly upper part of the abdomen, just off the midline.
Are inguinal hernia cases very common?
Inguinal hernias develop in approximately 1 to 3% of the total population of healthy children. This ratio is about 10 times higher in premature infants. In a similar way, the ratio is 10 times higher in boys when compared to girls. 60% of hernias occur on the right while 30% occur on the left and 10% occur on both sides. While 20% of the children who develop hernia in the right inguinal area while under age 1 also have hernia on the left side, 60 to 70% of the total population of children who develop hernia in the left inguinal area have hernia on the right side as well.
Therefore, it is recommended for children with inguinal hernia on the left to be examined for hernia on both sides during the first examination.
Are there similarities or differences between pediatric inguinal hernias and adult ones?
The inguinal hernia in children is defined as “indirect hernia”. In this condition, the abdominal organs enter through one end of the tunnel which consists of muscles and fascia, and exit through the other hand. The hernias encountered in adults are generally direct hernias. In these cases, the abdominal organs enter the said tunnel through a weak spot or opening in the lower wall facing the body and exit through the lower end.
While it is sometimes thought that the treatment of pediatric hernias is easier, the weakened spot in these cases cannot be repaired with a patch or sutures like it is in adult hernias. Furthermore, hernia surgery on children becomes a very important and sensitive issue when it is considered that children’s tissues are small and delicate, and the blood vessels and seminal duct that reaches the testicles need to be freed from a hernia sac which can be as thin as the skin of an onion.
Can inguinal hernia reoccur in a child in later ages?
Yes! It should never be forgotten that a child who undergoes surgery for indirect hernia can develop direct hernia during adulthood.
Which symptoms should families look out for in this case? When should they consult a doctor?
There is no possibility for a mother to miss any swelling on her child’s groin area while changing his diaper. Therefore, those who can describe the symptoms of hernia the best are mothers. Small hernias, on the other hand, can be detected during routine examinations by pediatricians. Sometimes, hernias are identified during ultrasound procedures which are performed for other reasons. However, these are rare. The organs that are most common in a hernia sac are the small intestines, followed by appendices and, on a less frequent basis, the large intestines. In girls, the most common organs in the sac are ovaries. In pediatric hernia cases where the hernia sac contains intestines, doctors attempt to return intestines into the abdomen; in cases where the hernia sac contains the ovaries, however, it is critically important to plan surgical treatment in a few days instead of returning the intestines into the abdomen.
“It is necessary for parents to be aware of the consequences of delays in hernia treatment and manage the treatment of their children smartly without becoming stuck on their worries and cooperating with their doctors.”
There are certain misconceptions among the public on the treatment of umbilical hernias. Professor Selim Aksöyek states that people used to apply methods such as sticking metal coins covered with cotton on the area of the swelling in the abdomen and says, “Studies show that such procedures do not accelerate the treatment process in any way. Since it is possible for the external pressure applied by such methods to cause even more damage by compressing tissues, they are not used any longer”.
How is surgery performed?
After the diagnosis, it is necessary for a surgical procedure for which the patient is most eligible to be performed without wasting any time. These types of operations, which are referred to as “outpatient surgery procedures”, do not require hospitalization. The patient is monitored for a certain period after undergoing the surgery in the morning and, once his eating capabilities are checked, discharged on the same day as the procedure.
The surgical intervention is performed via entry through a small incision on the inguinal area; the hernia sac, which extends outward from the inside of the abdomen, is freed by being separated from the blood vessels and the seminal duct leading to the testicles with extreme caution and connected back at a point as close as possible to the inside of the abdomen. This is followed by performance of a cosmetic suturing process on the incision area and closing off the said area with waterproof wound dressing.
What is umbilical hernia?
Umbilical hernias emerge when the anterior abdominal wall does not close off completely. To a large extent, the abdominal wall is supposed to close off by itself as the child develops. Swellings in the abdominal area of infants, which appear each time they cry or strain and disappear when the child calms down, cause great concern in parents. Although on a rare basis, incarceration of intestines in such hernia cases, which is referred to as “strangulation” can also be encountered. Umbilical hernias, as well as the swelling that accompany them, generally disappear by themselves as the abdominal wall continues to develop until the age of two.
Which methods are used in treatment?
Umbilical hernias which do not disappear until age two require surgical treatment. The outpatient surgery procedure which is performed for this purpose involves the repair of the opening in the abdominal wall with removal of the hernia sac via entry at a point level with the navel. Epigastric hernias, which are usually encountered on the upper abdomen, right off the midline, do not get better in time. Therefore, in such cases, diagnosis needs to be followed via surgical repair.