Inguinal hernia

Abstract

Inguinal hernia is one of the most common surgical conditions in infancy. Practically all infant hernias are of congenital indirect type. Medical conditions causing increased intra-abdominal pressure and connective tissue weakness predispose to inguinal hernias. Close to 5% of infants undergo hernia repair before the age of 6 months and in every fourth of those infants an emergent repair for incarceration, strangulation or repeated difficult reduction is performed. Thus hernia repair is indicated whenever a diagnosis has been made. Incarcerated or strangulated hernia is a paediatric surgical emergency and requires either manual reduction and subsequent repair or immediate surgery if reduction is not achieved. Elective repair of uncomplicated neonatal inguinal hernia is scheduled not later than 2-4 weeks following the diagnosis. In premature infants complicated hernias are repaired before discharge from NICU. In small infants the risk of apnoea requires appropriate facilities for postoperative monitoring after hernia repair. Neonatal inguinal hernia is repaired in the standard fashion of division and high ligation of the sac, but for a pediatric surgeon mastery of alternative incisions and laparoscopy is very useful. In a unilateral repair routine exploration of the asymptomatic contralateral groin is not recommended in any infant. Complication rate in the repair neonatal inguinal hernia is 1-5% including recurrence, testicular ascent, testicular atrophy, injury to vas deferens and injury to intestine, ovary, bladder and uterus. Neonatal hernia repair should have 0% mortality rate.