Causes of Swelling in the Groin in Children

These are hernias that develop in the inguinal region. Inguinal hernias constitute 75% of all hernias and are seen 25 times more frequently in men than in women.

What is an Inguinal Hernia?

There are three types called direct, indirect and femoral. In general, all three types are similar to each other, but the indirect one can be seen at any age and has the potential to go down to the scrotum. Femoral hernia occurs more rarely than other types. The same surgery is performed in the treatment of all three types.
Although inguinal hernia may seem harmless in general, your doctor will usually recommend surgery after examining you. Because the compression of the hernia and the complications that may develop after it can be daunting and even life-threatening.

What are the Symptoms of Inguinal Hernia?

Some inguinal hernias do not cause any complaints. Sometimes you may not realize that you have a hernia until it is detected during a doctor's examination. There is often swelling in the groin. This swelling is more obvious when standing, straining or coughing.

The swelling usually disappears when lying on your back. There may be burning on the swelling, a feeling of air when pressed, and pain. There may be a feeling of pressure in the groin area, pain and burning when lifting a heavy object. In less cases, swelling may occur in the scrotum due to the hernia descending into the scrotum. In the abdominal region, there are layers that protect the internal organs from external influences. These layers are skin, adipose tissue, abdominal anterior wall muscles and a thin membrane called peritoneum from the outside to the inside. All abdominal organs are placed in the peritoneum in an orderly manner.
Weakening may occur in some areas of this peritoneal tissue, and from these weak areas -usually the intestines- the internal organs of the abdomen may begin to make indentations towards the surface. This “herniation” is most common in the groin area; It is medically called “inguinal hernia”.

Inguinal hernia is initially painless and may not be felt. weak area in the peritoneum ruptures occur and a hole occurs and the hernia sac becomes more prominent on the skin. The inguinal hernia may initially be manually retracted into the peritoneal orifice. But this approach is wrong. There is always a danger of incarceration of such inguinal hernias.

What is a Stuck Inguinal Hernia?

Most of the time, the hernia bulge flattens when you lie on your back. This flattening occurs as a result of the return of the omentum or small intestine that enters the hernia sac back into the abdomen. If these organs cannot return to the abdomen and remain in the hernia sac, it is called a stuck hernia.

This situation is often intensely painful. If the blood flow feeding the organs in the compressed area is also cut off as a result of the compression, this is called a strangulated hernia (strangulated hernia), which is the next stage. Strangle hernias, unfortunately, require emergency surgery and may result in life-threatening complications. inability to perform ablution,

Abdominal bloating and feeling of gas pain,

Fever,

Increased heart rate,

Rapidly exacerbated abdominal and groin pain,

There may be bruising or redness in the color of the hernia bulge.

What are the Causes of Inguinal Hernias?

In some cases, there may be no detectable cause. But the following can be counted among the causes of hernia:

• Increased intra-abdominal pressure,
• Pre-existing weak spots in the abdominal wall,
• Straining during bowel movements or urination (prostate enlargement and enlargement of the prostate) chronic constipation),
• Heavy lifting,
• Fluid accumulation in the abdomen (ascitic fluid may accumulate in liver diseases or heart failure),
• Pregnancy,
• Overweight,
• Chronic coughing and sneezing.

Men have a congenital weakness in the inguinal canal. In male babies, the testicles form in the abdomen and then descend into the scrotum through the inguinal canal. The canal closes shortly after birth. Sometimes this canal cannot close properly and a weak spot occurs here. For this reason, inguinal hernia is more common in men.

Risk factors in the formation of inguinal hernia: 

• Some diseases (chronic lung diseases, COPD, pr ostat diseases, cirrhosis),
• Family history (if you have a hernia history in your close relatives, you are more likely to have it than the normal population)
• Chronic cough (smoking),
• Chronic constipation,
• Excessive weight (increases your intra-abdominal pressure),
• Pregnancy (weakens your abdominal muscles and increases intra-abdominal pressure),
• Some occupations (long Occupations that require standing for a long time and having heavy physical working conditions and requiring heavy lifting),
• To be born prematurely,
• To have had a hernia on the opposite side before.

The complications of inguinal hernia to be feared are;

• From the growth of the hernia over time and proper descent of the scrotum,
• Compression of the hernia (it can get stuck and cause intestinal obstruction),
• Suffocation of the hernia (impaired blood supply to the compressed intestine) gangrene and it can turn into a life-threatening complication.

How is Inguinal Hernia Surgery Performed?

In the open surgery method, 6-7 cm incision is made into the inguinal hernia. An incision is made and the organs inside the hernia are inserted into the abdomen and the top of the torn area is sutured.A synthetic hernia patch (Mesh) is also placed over this sutured area, since the tissues are often weak. These patches are made of materials that the body rarely reacts to. 
Final At times, self-adhesive patches are used that do not require stitches anymore.In laparoscopic (closed) surgery, the hernia area is reached by means of a thin camera by entering through 3 small holes, and after the hernia is evacuated, a patch is placed just like in open surgery. Similar procedures are performed in open and closed surgery, but closed surgery is more comfortable and painless compared to open surgery.

If your hernia is stuck or strangulated

If general anesthesia is inconvenient,

Open surgery should be preferred if there is a very large hernia tear.

The advantages of closed (laparoscopic) surgery in inguinal hernia;

• Each of 3 small holes in bilateral hernias It gives the chance to operate on both sides.
• It is superior to reoperation on open surgeries with recurrent hernia,
• Pain after surgery is very less.
  
• Post-operative In this period, the time to return to normal life and work is shorter.
  
• It leaves a faint trace cosmetically.

The post-operative period in inguinal hernia is after the patient recovers from the effect of anesthesia (ie 3- 3 4 hours later) begins to eat. He can get up in the evening. Most patients are discharged the next day. Since self-dissolving sutures are mostly used, there is no suture removal. Patients can start taking a bath from the next day.
Points to be considered in the late postoperative period:

• Be careful not to lift heavy for 6 weeks.
• Weight-lifting sports should be interrupted for 6 weeks.
• Be careful not to gain weight.
• It is recommended to quit smoking.

There is no restriction on doing the following after the surgery.

• No food restriction.
• After 1 week you can swim in the pool or sea.
• You can start work as soon as you feel comfortable.
• You can drive after 2 weeks.
• 1 day after sexual intercourse You can enter a relationship.

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