Paediatric Hernias: Early Detection, Treatment, and Care

Paediatric hernias are typically diagnosed through a combination of physical examination, medical history assessment, and in some cases, imaging tests.

• Physical Examination: The doctor will carefully examine the child’s abdomen and groin area for visible bulges, especially when the child cries, coughs, and strains. The doctor will also gently palpate the area to identify any masses or tenderness.
• Medical History: The doctor will inquire about the child's symptoms, which helps them determine the type of hernia and identify any underlying risk factors.
• Ultrasound: An ultrasound allows the visualisation of the hernia sac and its contents, aiding in diagnosing inguinal hernias.
• CT Scans: CT scans can provide more detailed information about the abdominal wall and surrounding structures. It can be used to identify potential complications, such as bowel obstruction or strangulation.
• MRI: MRI can provide excellent soft tissue contrast, allowing for detailed visualisation of the hernia sac, surrounding muscles, and nerves. This is particularly valuable for assessing complex hernias or those potentially involving nerve compression.

Paediatric hernias can be addressed through different treatment approaches depending on the type, severity, and presence of complications. While some hernias resolve naturally, others require surgical intervention.

Non-Surgical Management

This approach involves observation and watchful waiting, as the vast majority of umbilical hernias close spontaneously by the age of five. Regular check-ups are crucial to monitor the hernia's progress. The doctor will assess whether the hernia is shrinking naturally and if there are any signs of complications.

Surgical Options

Inguinal hernias are generally treated with surgery. Surgery may also be recommended if a hernia does not close on its own, is large, or causes incarceration. There are two approaches used for paediatric hernia repair:

• Open Hernia Surgery: This traditional surgical method involves a direct incision near the hernia site to repair it. It effectively treats all types of hernias, including complex and emergency cases.
• Laparoscopic Surgery: This minimally invasive procedure involves creating several small incisions in the abdomen. Through these incisions, a tiny camera and specialised surgical instruments are inserted to repair the hernia.

Most children are discharged from the hospital on the same day or within 24 hours after hernia repair surgery unless complications arise. Recovery time varies depending on the extent of the procedure: minor repairs typically take 1–2 weeks, while more extensive repairs may take up to a month.

To manage post-surgical pain and discomfort, your child's specialist will prescribe pain relievers. To prevent infection, avoid giving your child a full bath for 2–3 days after surgery. Sponge baths are recommended during this time. The specialist may also provide an ointment for wound care.

Small adhesive strips will cover the incisions. Over time, these strips should fall off naturally. To ensure proper wound healing, do not attempt to remove them yourself. If the strips remain in place, the specialist will carefully remove them during the follow-up appointment.

Parents should carefully monitor their child for signs of complications. These may include:

• High Fever: A temperature higher than 38.5˚C
• Foul-smelling Drainage: Any unusual or unpleasant odour coming from the incision site
• Bleeding or Increased Pain: Around the incision area

If you notice any of these signs, contact the surgeon immediately for further evaluation and guidance.

In most cases, hernia repair allows patients to live a normal, healthy life without any significant limitations. However, there is a small chance of the hernia recurring after surgery. About 16% of people who undergo a hernia repair may require additional surgery due to hernia recurrence within 10 years. However, recurrence rates can vary significantly depending on several factors, including the type of hernia and the surgical approach used.

Left untreated, paediatric hernias can lead to serious complications, such as:

• Incarceration: Incarceration occurs when the herniated tissue gets stuck in the opening of the abdominal wall. When this happens, the trapped tissue cannot be easily pushed back into the child’s abdomen.
• Strangulation: When a hernia gets stuck, strangulation can occur. This is a life-threatening condition where the blood supply to the intestines gets cut off. This lack of blood flow to the intestines can potentially lead to tissue death.