How does inguinal hernia, one of the most common surgeries performed by pediatric surgeons, occur? While the child is in the womb, the testicles of the child are also inside the child's abdomen. Close to birth, the testicles descend into the bag we call the scrotum. After this stage, the inner ring of the inguinal canal closes with the melting of the membrane called processus vaginalis, which is open until the passage of the testicle. There is no connection between the inside of the abdomen and the scrotum. If this membrane does not close, a formation called inguinal hernia occurs.
While it is seen with a frequency of 1-3% in term babies, this rate is higher in premature babies. It is more common in boys than girls and is more likely to be on the right side.
Hernia can occur at any time from the neonatal period. In cases where intra-abdominal pressure increases, the fat layer called omentum covering the intestines or intra-abdominal organs in boys often occurs, and in girls, the ovaries and intestines often enter this sac, causing a swelling in the groin area. The most important sign of a hernia is that this swelling swells and disappears. The family sees this swelling and consults a pediatric surgeon. The treatment is definitely surgery. Once diagnosed, surgery should be performed as soon as possible. Reason for surgery; There is a possibility of encountering a life-threatening condition resulting in structures such as intestines and ovaries entering the hernia sac (incarceration) and when it is too late, the circulation of the trapped organ is disrupted and gangrene is caused (strangulation)
It should be operated on in a timely manner. It is a day surgery. After 5-6 hours of fasting, hernia surgery is performed with a surgery that takes approximately 0.5-1 hour.
Although hernia surgery seems like a simple procedure, it is an operation that requires high technical skills and experience. A 1.5-2 cm transverse incision is made in the inguinal region, on a line called the weight line, and the hernia sac is located and separated from the testicular vessels and spermatic cord. The sac is tied at the point where it should be closed anatomically, at the level of the inner ring of the inguinal canal. During these procedures, especially in young children, the possibility of an inexperienced surgeon damaging the testicular vessels and spermatic cord is quite high.
Although laparoscopic hernia surgery is performed in children, most pediatric surgeons do not prefer the laparoscopic approach because the hernia surgery incision in children is about 1.5 cm. Additionally, this approach is not as anatomical as open surgery. The chance of recurrence is slightly higher.
HYDROCELE (WATER HERNIA)
The mechanisms described in hernia are also valid in hydrocele. The feature that distinguishes hydrocele from hernia is that the open processus vaginalis allows the entry of only intra-abdominal fluid, not the organs, and therefore hernia strangulation is out of the question. Because of this feature, hydrocele cannot be operated on immediately like a hernia. If it is waited until the age of 1 and if it does not close, then it will be repaired like a hernia. Hydrocele, which does not regress until the age of 2, is unlikely to go away. Surgery must be performed.
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