What is it?
A hernia is a weakness or gap in the muscles which form the front of the tummy. In your child's case the weakness is in the groin.
The area of the hernia gets swollen because organs within the tummy are pushing through the weak spot. It will get bigger and cause pain if it is left untreated.
It is possible that the some organs get trapped in the gap and cannot go back in the tummy. This can be very painful and very dangerous It is not the fault of either parent.
An inguinal hernia is 10 times more frequent in boys than girls.
A cut is made into the skin overlying the hernia. Whatever organs are pushing through the weak spot are freed and placed back in the tummy and the weak spot or gap is closed with strong stitches.
Sometimes a plastic patch can be stitched over the gap to close it. This way of closing the gap can be used on its own or in combination with the strong stitches. The surgeon usually makes a decision at the time of the operation. The cut in the skin is then closed up.
Usually you can take your child home in 2-3 days. If the operation is done urgently for hernia that has become very painful your child might have to stay in the hospital for 3-5 days.
There is no sensible alternative to an operation. Inguinal hernias never close spontaneously. Usually the, hernias get bigger and more uncomfortable.
There are no suitable supports or trusses for these hernias. Although there is nothing a parent can do to prevent a hernia from happening, talking to a doctor as soon as there is any complain from the child and any suspicion of hernia is extremely important.
If the hernia is not repaired the greatest danger to the child is the abdominal organs getting trapped in the hernia. This usually happens after some excess physical activity and it can be very painful.
Even worse, the organs that get trapped in the hernia can get strangulated, the blood supply to them can stop and they get necrotic (die). This serious condition is called an incarcerated hernia.
If this happens the child must be taken to hospital urgently and an emergency operation will be needed to fix the problem. If your child has a hernia, you should be alert to this potential situation and seek medical advice urgently if you have any suspicions that your child is getting rather uncomfortable in or around the area of the hernia. For these reasons. it is very important to proceed with the hernia repair before your child experiences such problems.
Before the operation
Your child must have nothing to eat or drink for about six hours before the operation. This means not even a sip of water. Your child's stomach needs to be empty so that the anaesthetic can be administered safely.
If your child has a cold in the week before admission to the hospital, please telephone the ward and let the ward sister know. The operation will usually need to be put off. Your child has to get over the cold before the operation can be done because by having an anaesthetic the cold could turn into a serious infection in the chest.
Sort out any tablets, medicines, inhalers that your child is using. Keep them in their original boxes and packets. Bring them to the hospital with you.
On the ward, your child will be checked for past illnesses and will have special tests to make sure that he or she is well prepared and can have the operation as safely as possible.
Please tell the doctors and nurses of any allergies to tablets, medicines or dressings.
You and your child will have the operation explained to you and you will be asked to fill in an operation consent form. Before you sign the consent form giving permission for the operation to go ahead, make sure that you understand well all the information that was given to you regarding your child's health, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.
Many hospitals now run special preadmission clinics, where you and your child visit for an hour or two, a week or so before the operation for these checks.
After – in hospital
Your child will be sleepy after the operation and is likely to sleep for an hour or more afterwards.
The drugs given for a general anaesthetic will make your child clumsy, slow and forgetful for about 24 hours. This happens even if your child feels quite alright. Do not leave your child on his or her own or let your child use anything sharp or dangerous.
Your child will probably not notice any particular pains. If necessary your child can take a paracetamol in liquid to control the pain. By the end of one week the wound should be virtually pain-free.
Your child will be able to drink again a couple of hours or so after the operation. He or she should be able to eat normally the next day. Eating and drinking might be delayed if the operation is done urgently because the bowel can get swollen and lazy an takes it a few more day to recover.
There may be stitches or clips in the skin. The wound may be held together with stitches under the skin that dissolve and don't need to be removed. There may be some swelling of the surrounding skin which improves after about two or three days. This is expected and you should not worry about it.
After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so.
You can wash your child but try to keep the wound area dry until the stitches or clips come out or for about a week if there only stitches under the skin. Salt water is not necessary.
Some hospitals arrange a check-up about one month after you leave the hospital. Others leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.
After – at home
Your child may need frequent sleeps for a day or two. Although it is usually difficult to limit what he or she does, try to help your child to avoid any excess physical activity for four to six weeks after the operation especially if he or she is over five years old.
It is also important for the first 4-6 weeks to avoid any scratching or trauma to the wound because this can cause some bleeding or an infection and can weaken the repair of the hernia.
If your child goes to school he or she can return to lessons in 10 days or so. Your child can restart any sport after about four to six weeks.
As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs.
The risks of the anaesthetic increase if your child is having the operation urgently for a very painful hernia with organ trapped, and possible strangulated, in the hernia gap The tests that your child will have before the operation will make sure that he or she can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Complications are rare and seldom serious. If you think that something is wrong let the doctors and the nurses know.
There is often some swelling and even some redness around the wound. These usually settle in three or four days.
Infection is a rare problem and settles down with antibiotics in a week or two. It is very rare for the hernia to form again. The risk or recurrence is less than 1 in 100. This is more common in children who have a wound infection after the operation or who don't avoid any excess physical activity for the first four to six weeks.
If you have any queries or problems, please ask the doctors or nurses.