eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Pediatric Hernias: Follow-up

Author: Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Oct 21, 2009

Follow-up

Further Inpatient Care

  • Most patients who undergo elective repair of an inguinal or umbilical hernia are discharged from the hospital shortly after surgery. Overnight observation is indicated only in small premature babies who are at risk for postoperative apnea. Such patients are usually admitted for 24-hour observation and monitoring in the hospital.

Further Outpatient Care

  • Routine follow-up care after operative repair of an inguinal hernia typically requires only one office visit or telephone consultation if the parents have reported no problems or complications. Scrotal swelling and bruising after surgery are common and may last for 1-3 weeks. Such signs do not indicate any complications; they represent normal postoperative changes.

Inpatient & Outpatient Medications

  • Most patients are treated with acetaminophen for 24-48 hours after surgery. Codeine is occasionally added for pain management in older children (>1 y).

Transfer

  • Transfer to a facility with pediatric surgical expertise is indicated in premature babies with inguinal hernias or in the event of inguinal hernia incarceration and/or strangulation.

Complications

  • Few complications result from operative repair of an inguinal hernia. Possible consequences of hernia repair include decreased testicular size (£ 20% of patients), testicular atrophy (1-2%), vas injury (<1%), and development of sperm-agglutinating antibodies. The risk of gonadal injury in females is low. Fortunately, in the hands of pediatric surgeons, such complications are quite rare.
  • The incidence of wound infection is 1-2%.
  • Hernia recurrence rates are around 1% when experienced pediatric surgeons perform the operation. Factors associated with recurrence of inguinal hernia include an unrecognized tear in the sac, failure to repair an enlarged inguinal ring, damage to the canal and inguinal floor, infection, history of incarceration, connective tissue disorder, and conditions producing increased intra-abdominal pressure (eg, chronic respiratory problems, constipation). The hernia recurrence rate with the laparoscopic technique has been reported to be higher if the surgeon is still in the "learning curve." However, in the hands of an experienced surgeon, the recurrence rate for the laparoscopic technique should be similar to the one reported for the open technique.
  • The vas deferens and ilioinguinal nerve occasionally may be injured and should be repaired with 7-0 or 8-0 Maxon sutures. This may be technically difficult because of the extremely small vas lumen not traversed by semen. One infertility expert advises marking the ends of the vas with permanent suture and performing vasovasotomy after puberty with a 2-layer closure. It is also important to remember that the finding of vas or epididymis on the surgical pathology report does not necessarily imply injury because embryonal müllerian remnants have been recognized in 1-6% of surgical specimens. Specific histologic features of the remnant include a smaller diameter and failure to show a prominent muscular wall with Masson trichrome staining.

Prognosis

  • Overall prognosis is excellent; most patients do extremely well after operative repair of their inguinal hernia. Mortality is extremely rare but, unfortunately, continues to be reported as a consequence of delayed recognition of an incarcerated and strangulated inguinal hernia.

Patient Education

  • Instruct parents and caretakers on the signs and symptoms of inguinal hernia incarceration. Delayed recognition of incarceration is likely to result in significant morbidity and mortality for the child.
  • For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article, Hernia.

Miscellaneous

Medicolegal Pitfalls

  • Delayed recognition of incarceration is likely to result in significant morbidity and mortality for the child. Possible consequences of hernia repair include the following:
    • Decreased testicular size
    • Testicular atrophy
    • Vas injury
    • Development of sperm-agglutinating antibodies
    • Injury to the vas deferens and ilioinguinal nerve
    • Gonadal injury in females
  • Failure to recognize a tear in the sac and failure to repair an enlarged inguinal ring are associated with recurrence of inguinal hernia.
 


More on Pediatric Hernias

Overview: Pediatric Hernias
Differential Diagnoses & Workup: Pediatric Hernias
Treatment & Medication: Pediatric Hernias
Follow-up: Pediatric Hernias
Multimedia: Pediatric Hernias
References
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References

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  9. Matsuda T, Muguruma K, Horii Y, et al. Serum antisperm antibodies in men with vas deferens obstruction caused by childhood inguinal herniorrhaphy. Fertil Steril. May 1993;59(5):1095-7. [Medline].

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Further Reading

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Keywords

pediatric hernias, inguinal hernia, indirect inguinal hernia, groin hernia, umbilical hernia, femoral hernias, incarcerated hernia, strangulated hernia, hydrocele, prematurity, gonadal dysfunction, intestinal necrosis, intestinal perforation, intestinal obstruction, treatment, diagnosis

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Contributor Information and Disclosures

Author

Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey J DuBois, MD, Consulting Staff, Division of Pediatric Surgery, Kaiser Permanente, North Sacramento Medical Center
Jeffrey J DuBois, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Academic Surgery, California Medical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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