Inguinal hernias in children
When children have inguinal (groin) hernias, they are usually born with them. These hernias don’t go away again on their own and can cause complications, so they are always treated with surgery.
As a baby boy grows in his mother’s womb, his testicles form inside his abdomen. Shortly before or after birth they move (“drop”) down into a pouch of skin known as the scrotum, through the inguinal canal. If the inguinal canal is not yet fully closed, inguinal (groin) hernias are more likely to develop. Then areas of fat tissue or parts of the bowel bulge out through gaps in the abdominal wall. Girls can have inguinal hernias too, but that is rare.
About 5 out of 100 babies are born with an inguinal hernia. The risk is higher in babies who are born too early (preterm babies).
What do inguinal hernias look like?
Inguinal hernias can be seen as a bump in the groin area – sometimes only when the baby is crying or straining. They often occur on both sides of the body. In most cases they don’t cause any bothersome symptoms, but can sometimes lead to a sharp, pulling pain.
If the hernia sac moves downward, it can cause swelling in the boy's scrotum or in the 'lips' on the outside of the girl’s genitals (her labia). Doctors can usually feel the hernia from outside the body. They can do an ultrasound scan too.
What risks are associated with inguinal hernias?
Abdominal tissue or a part of the bowel might get pinched in the opening of the hernia. This is known as a strangulated hernia. It usually leads to sudden pain. The child is then very restless and cries a lot. He or she might drink less and vomit. If the pinched area becomes inflamed, the child may develop a fever. The hernia sac might become red. A strangulated hernia urgently needs to be treated with surgery because it can be life-threatening. So it’s important to drive to a hospital as soon as possible or call an ambulance (112 in Germany and most European countries, or 911 in the U.S.).
What are the treatment options for inguinal hernias?
If a child has an inguinal hernia, it is always treated with surgery. The need for surgery will be more urgent in some children than in others, depending on their age and how severe the hernia is. The hernia is usually operated on in the first few weeks or months after it is diagnosed. The risks associated with the surgery are also taken into consideration here: There are more risks if the baby is very young or was born too early (preterm).
The child is usually given a general anesthetic during the surgery. The surgeon typically only makes a very small cut in the skin. Keyhole surgery (also known as minimally invasive or laparoscopic surgery) is also an option. The opening of the hernia is usually closed off by sewing it on to neighboring body tissues. A mesh isn’t used. Sometimes the surgery can be done as an outpatient procedure, and then the child can go home on the same day.
Olesen CS, Andresen K, Öberg S, Rosenberg J. Laparoscopic versus open repair of groin hernias in children: a systematic review and meta-analysis. Surg Endosc 2019; 33(7): 2050-2060.
Wang KS. Assessment and management of inguinal hernia in infants. Pediatrics 2012; 130(4): 768-773.
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