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What are they? They are weak areas in the abdominal wall that allow your child’s intestines, or other organs, to bulge out into the groin.
Where are they? Inguinal hernias are found just below pant-line on the right and left. They are very close to your child’s private area and may cause bulging of the scrotum in a boy, or the labia in a girl.
Who gets them? Both boys and girls can get hernias, but it is more common in boys. It is also more common in babies who are born prematurely.
What causes them? There is a natural tunnel in the abdominal wall that is present when a baby is developing. In boys the testicles are located inside of the abdomen and they pass though this tunnel and into the scrotum before birth. The tunnel is supposed to close automatically after that, but sometimes it does not close properly.
Why do they have to be fixed? When this tunnel remains open, other organs can get stuck inside it and squeezed. Most of the time it is a piece of the intestine. Sometimes, in girls, one of the ovaries can get stuck in the tunnel. Once an organ gets stuck it can be squeezed so tightly that the blood supply is cut off. If this happens to a piece of intestine your child can get very sick and may lose part of the intestines. We fix all inguinal hernias to prevent these complications.
How are they fixed? Your child will go to the operating room and be put to sleep. A 1-inch incision is made over the area of the hernia, and the “tunnel” though the wall of the stomach is explored. We empty all of the important organs, blood vessels, and nerves from inside of the tunnel and then we use stitches to close the tunnel so that nothing else can get through. If your child was born prematurely we will usually look at both sides and fix both hernias during the operation. This is sometimes done by putting a laparoscope (camera) into to abdomen and looking at the tunnel from the inside. Most children go home the same day and do not stay in the hospital.
Who has to stay in the hospital? If your child was born prematurely and is still very young he or she might have to stay overnight in the hospital. Very young babies have immature lungs and sometimes take longer to recover after being put to sleep for surgery. They usually stay in the hospital overnight and go home the next day.
Will my child be in pain? Usually not. They are under general anesthesia during the operation and will feel nothing. All babies will get some pain medicine injected into the surgical incision, or into the nerves near the incision, while they are in the operating room to eliminate pain. This medicine lasts for several hours. Then children may only need Tylenol or Motrin to control pain. But they may not need any more pain medicine at all.
What about complications? Occasionally there is bleeding or infection at the incision, or recurrence of the hernia. There is also a 1% chance of injury to the spermatic cord.
Umbilical Hernia
What are they? It is a defect in the abdominal wall directly behind the belly button. This hole lets the intestines push through the abdominal wall and makes a soft bulge at the belly button. It may be very small and look just like an “outie” belly button, or it may be very large and look like an elephant’s trunk.
What causes them? When a baby is developing inside the mother, there is a time when the intestines are actually outside of the body. The intestines then come back inside the body through the belly button—kind of like a front door into your abdomen. Then the door is supposed to close. But in some children the door does not close all the way and there is a small hole left in the abdominal wall that becomes the hernia.
Is it dangerous? No. In fact, given time, most umbilical hernias go away by themselves. The door is actually closing properly, it is just occurring very slowly. If you notice that the hernia is getting smaller over time, it might go away completely by the time your child is 3-4 years old.
So why do we fix them? Sometimes the door does not close by itself. So if your child is nearing kindergarten-age and still has an umbilical hernia, it will need to be fixed with surgery. Surgery is performed in younger children if the hernia seems to be getting bigger instead of smaller, or if the stuff squishing out the hole seems to get stuck. We also fix very large umbilical hernias to make them look better.
How do we fix them? In the operating room. A small incision is made around the edge of the belly button and the hole in the stomach wall is located underneath it. The hole is sewn shut with large stitches and then the belly button is placed back over the top of the hole. Your child will have one Band-Aid covering his belly button after surgery, and all of the stitches will be underneath the skin. The stitches will dissolve by themselves over time.
What should I expect? Most of these surgeries take place as an outpatient. Your child will not be allowed to eat or drink anything for about 6 hours before the surgery. When you show up to the hospital your child will be checked in to a room and evaluated by the anesthesiologist. They will get some medicine to help them relax before going to the OR. They breathe a special gas to put them to sleep and then they get an IV after they are asleep. After the surgery they will come back to their room acting very sleepy and with the IV in place. You get to go home when they are awake and able to drink.
Complications? Bleeding or infection of the incision. Sometimes hernias come back.
Will my child be in pain? Usually no. During surgery some medicine will be injected into the belly button to numb the pain. Tylenol usually helps after that.
Then What? Your child’s wound will heal in a week or two and you will see your surgeon for a follow up appointment.
Hydrocele
A hydrocele is a collection of sterile fluid surrounding but not involving one or both testicles. Hydroceles are common in newborns, especially those born prematurely. A simple hydrocele is basically an isolated sac of fluid and has no connection to the peritoneal cavity (the cavity in which the intestines and other organs reside). A simple hydrocele requires no treatment and will usually resolve within the first year of life. A “communicating” hydrocele does posses a communication with the peritoneal cavity and in this fashion is similar to a hernia (see picture). This type of hydrocele will not resolve spontaneously and will persist beyond the first year of life, usually changing in size during the course of a day. A communicating hydrocele does require outpatient surgery to remove the communication and drain the fluid as these will only increase in size and difficulty to treat.
Hydroceles may also be diagnosed with ultrasound which is painless and involves no radiation. If you believe your child has a hydrocele and would like to discuss treatment options with one of our physicians, please call (865)546-2131 or email info@etpsg.com.
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