Inguinal hernia/ hydrocele
What is a hernia? What is a hydrocele?
A small passage has developed, or left open connecting the belly to the baby’s groin. In a hernia bowel pokes out through this, mainly when the baby cries. In hydrocele the water from inside is popping out instead of intestine as the passage is too small.
Is an operation needed? If yes when?
The intestine in the hernia usually moves in and out of the abdomen quite easily. Sometimes the intestine may get stuck in the hernia leading to blockage of, and possibly damage to the intestine or to the blood vessels to the testicle. If this happens emergency surgery may be needed and the intestine or testicle may be damaged. It is advisable to fix the hernia as soon as diagnosis before complications develop.
However in a case of hydrocele, the passage is too small, and its only fluid. So one can wait up to 2-4 years of age before surgery. In more than 50% it can correct by itself. If this does not happen surgery is required.
What does the operation involve?
The operation is same for a hernia and a hydrocele in children. Under anaesthetic a cut will be made in the baby’s groin. The passage or hole is closed with stitches and the skin closed with stitches under the surface. A small dressing may be applied. Local anaesthetic will also be used to numb the skin so as to reduce any pain the baby may feel after waking. Your baby will then be woken up and returned to the high care nursery.
What happens following the surgery?
Occasionally following anaesthetic we know that babies may have a change in their breathing pattern for a few hours, therefore your baby will be observed carefully. Milk feeds can be given as soon as your baby demands. Usually your baby should be ready to return home the same day. If the baby is very small the baby would be discharged the next morning.
What are the complications and risks of the operation?
Surgery is usually very straightforward. However there can be difficulties in small babies. In boys the area is very close to the blood vessels that go to the testicle. The hernia itself can damage these blood vessels especially if it gets stuck before surgery but the surgeon must also be careful to protect the vessels as injury to them can affect growth of the testicle in later life.
Bruising at the site of hernia repair can be quite marked and can cause some swelling in a few babies. It usually resolves in a few days.
In rare cases the hernia may come back and a further operation may then be needed. Occasionally the testicle may become higher during the first few years of life and an operation is needed to fix the testicle down.
Although most babies only have a hernia on one side, some have a hernia on both sides at the time of surgery. Some babies who only have one hernia can develop another hernia within the next two years requiring a later operation.
Can a girl baby get a hernia?
Yes. In these children the ovarian tissue may pop out like bowel and it may get stuck. Very rarely a girl with a hernia will have some male chromosome material. This can have implications for later life but a blood test to look at the baby’s chromosomes can be done to exclude this condition.