Inguinal hernia is a type of ventral hernia that occurs when an intra-abdominal structure, such as bowel or omentum, protrudes through a defect in the abdominal wall. Inguinal hernia occurs when the patent process vaginalis fails to obliterate after birth. The processus vaginalis is an outpouching of peritoneum attached to the testicle that trails behind as it descends retroperitoneally into the scrotum.[1].

Most hernias that are present at birth or in childhood are indirect inguinal hernias. Premature infants are at increased risk for inguinal hernia, with incidence rates of 2% in females and 7-30% in males. Approximately 5% of all males develop a hernia during their lifetime.

The infant or child with an inguinal hernia generally presents with an obvious bulge at the internal or external ring or within the scrotum. The parents typically provide the history of a visible swelling or bulge, commonly intermittent, in the inguinoscrotal region in boys and inguinolabial region in girls. The bulge commonly occurs after crying or straining and often resolves during the night while the baby is sleeping.

Physical examination of a child with an inguinal hernia typically reveals a palpable smooth mass originating from the external ring lateral to the pubic tubercle. The mass may only be noticeable after coughing or performing a Valsalva maneuver, and it should be reduced easily. In girls, feeling the ovary in the hernia sac is not unusual. In boys, palpation of both testicles is important to rule out an undescended or retractile testicle.

Ultrasonography  maybe done  to differentiate between a hydrocele and an inguinal hernia. Ultrasonography is capable of finding a fluid-filled sac in the scrotum, which would be compatible with a diagnosis of hydrocele.

Inguinal hernia repair is one of the most common pediatric operations performed. For inguinal hernia, elective herniorrhaphy is indicated to prevent incarceration and subsequent strangulation. Hernia repair is an outpatient procedure in the otherwise healthy full-term infant or child.

High ligation and excision of the patent sac with anatomic closure, is the most common operative technique, which can be accomplished with an open or laparoscopic technique

Diagnostic laparoscopy is a very effective method for determining the presence of an inguinal hernia but is used only selectively because it requires anesthesia and surgery. Laparoscopy can be useful to assess the contralateral side (see Treatment) or to evaluate for presence of a recurrent inguinal hernia in patients with a history of operative repair. Standard laparoscopy is performed via a small 5-mm umbilical port with a 5-mm, 30 º- angled laparoscope. Once the indirect inguinal hernia is identified, the laparoscopic repair is performed.

Laparoscopic hernia repair  is an efficient, safe, and effective minimally invasive alternative to open repair, with reduced operative times, in cases of bilateral hernia and obese children.

 

References.

1. Chang SJ, Chen JY, Hsu CK, Chuang FC, Yang SS. The incidence of inguinal hernia and associated risk factors of incarceration in pediatric inguinal hernia: a nation-wide longitudinal population-based study.Hernia. 2016 Aug. 20 (4):559-63
2. Deeba S, Purkayastha S, Paraskevas P, et al. Laparoscopic approach to incarcerated and strangulated inguinal hernias.JSLS. 2009 Jul-Sep. 13(3):327-31.
3. Lukong CS. Surgical techniques of laparoscopic inguinal hernia repair in childhood: a critical appraisal.J Surg Tech Case Rep. 2012 Jan. 4(1):1-5.
4. Esposito C, St Peter SD, Escolino M, Juang D, Settimi A, Holcomb GW 3rd. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review.J Laparoendosc Adv Surg Tech A. 2014 Nov. 24(11):811-8.