Kids Get Hernias, Too
- Dr. Graham Cosper
“My child has a hernia? I thought that only happens to adults!” We frequently hear this from surprised parents in the office, but the answer is, “Yes, your child can get a hernia.” In fact, hernia repair is one of the most common operations for pediatric patients.
So what exactly is a hernia? It is a hole in the abdominal wall musculature through which abdominal contents can protrude. There are three types of abdominal wall hernias that we routinely see in children:
1. Umbilical hernia
For newborns, after the umbilical cord stump falls off, the skin and muscle contract, closing the hole where the umbilical cord had been. If this process does not occur completely, a defect in the muscle persists. The skin of the belly button will have a soft bulge that can be pushed back in. These bulges, commonly referred to as “outie” belly buttons, are abdominal fat or intestines pushing up under the skin. Umbilical hernias will often close on their own in the first few years of life. Beyond age three or four, however, the defect will not close spontaneously and will likely require surgical repair. Most children with umbilical hernia undergo repair between age three and five. These operations are performed under light general anesthesia as out-patient procedures. Small incisions are made but are hidden in the belly button skin, and the entire procedure takes between 20 and 40 minutes. Most children have soreness for 48 to 72 hours but are usually back to normal within five to 10 days, depending on the age of the child and the size of the hernia.
2. Inguinal hernia and hydrocele
During fetal life, boys’ testes and girls’ ovaries develop high in the abdomen near the kidneys. They are connected to the groin by a cord-like structure called the gubernaculum, which guides their descent into the pelvis. In girls, the ovaries settle in the pelvis next to the uterus. In boys, the testes continue to descend through openings in the groin muscle and settle in the scrotum. In both boys and girls, a small opening in the groin muscle remains. Usually these openings close in infancy, but, in about four percent of boys and one percent of girls, the opening does not close properly, leading to an inguinal hernia or a hydrocele. (Learn the difference between the two.) In premature infants, inguinal hernia is much more common, appearing 30 to 40 percent of the time.
Inguinal hernias should be repaired within four to six weeks of diagnosis to avoid incarceration. Such hernias in children are not like those in adults, which often require closure with synthetic mesh. The operation in children involves tying off the sac-like projection of abdominal wall lining that passes through the inguinal canal, effectively closing the hole in the groin muscle. These operations are performed under general anesthesia through very small groin incisions and take less than an hour. Most children will be completely recovered within a week.
3. Epigastric hernia
These are small holes in the abdominal musculature between the belly button and the breast bone. Small bits of internal fat from the abdomen protrude through the hole, creating a knot under the skin that is most apparent when the child is standing up. The herniated fat can go in or out, or it may remain stuck within the hernia all the time. Epigastric hernias are usually not bothersome to children, but they do not go away on their own and slowly enlarge over time. Elective repair is recommended, not just for cosmetic reasons, but to avoid long-term problems such as the intestine getting stuck in the hernia during adolescence or adulthood. These operations are performed under light general anesthesia through very small incisions and take less than 30 minutes. Most children do not require pain medication other than Tylenol and will be completely recovered within several days. Complications of any kind are exceedingly rare.
If you have questions or concerns about the possibility of a hernia in your child, do not hesitate to get in touch with your pediatric surgeon.
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