Inguinal hernia is one of the most common surgically relevant diseases. However, the cause and therefore the treatment are different in children and adults. In adults, most hernias occur in the course of life. In children, almost all hernias are congenital. Unlike in adults, these are not caused by a weakening of the abdominal wall or a widening of the so-called hernial orifices. Instead, they are the result of a completely normal, albeit incomplete, developmental process. Even before birth, a corner of the peritoneum, which passes through the inguinal canal in every human being, should have closed spontaneously. If it does not close, the access in the peritoneal tip remains open. If intestinal loops or, in girls, often the ovary pushes into this access, the hernia sac, an inguinal hernia develops. This "bump" in the groin can often be very painful. Inguinal hernias never regress spontaneously and must always be surgically closed. In some cases (about 10%) these inguinal hernias are bilateral. Boys are affected almost ten times as often as girls. However, they are only an emergency if the contents of the hernia sac cannot be pushed back in and are trapped there. The patient should then be treated as quickly as possible in a pediatric surgical Clinical Department.

Water hernia (hydrocele)

A hydrocele is a special form of inguinal hernia. It develops in a similar way to an inguinal hernia. However, no intestinal loops or similar enter the hernia sac in a hydrocele hernia, as this is already closed in the uppermost section. However, the open part of the peritoneum can trap water, which then usually leads to an enlargement of the scrotum in boys. This type of hernia often resolves spontaneously and only requires surgery in exceptional cases. However, this decision should always be made together with a pediatric surgeon.

In the case of an inguinal or water hernia, the swelling in the child's groin is usually noticed by the parents, midwife or pediatrician. If it is an inguinal or water hernia, it will be confirmed by the pediatric surgeon during the clinical examination. Additional imaging examinations are generally unnecessary and should only be carried out by the pediatric surgeon in individual cases.

 

 

Once the inguinal hernia has been diagnosed, it should be treated surgically as soon as possible, as spontaneous closure does not occur and the risk of incarceration of the hernia sac contents is greater.

There are two surgical procedures available, the advantages and disadvantages of which the pediatric surgeon will explain to the parents in a personal consultation. Both procedures, the open and the minimally invasive procedure, are established and are offered by us.

 

Minimally invasive procedure:

For children weighing more than 3000g, we are happy to offer surgical closure using laparoscopy (laparoscopy), which involves making a small incision in the navel and inserting a small metal tube (trocar) into the abdominal cavity. A small camera is inserted through this and carbon dioxide is blown into the abdominal cavity, which causes the abdomen to bulge and allows the pediatric surgeon to see the abdominal cavity clearly. As soon as the hernial orifice has been identified, it can be closed via a very small incision in the groin. As part of this procedure, it is possible to check whether there is also an inguinal hernia on the opposite side that has not yet become clinically apparent. If so, this can be treated at the same session.

 

Open procedure:

In the open procedure, the pediatric surgeon makes a 2 cm long incision above the inguinal canal in an abdominal fold and closes the unadhered tip of the peritoneum with a suture. The scar is hardly noticeable later, as the incision follows the so-called cleavage lines of the skin. The suture is made of absorbable material. The stitches do not need to be removed later.