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Inguinal hernia/hydrocele

What is an inguinal hernia?

An inguinal (in-gwine-al) hernia is a bulge in the groin created by tissue or organs that are normally located with the belly. In boys, the bulge can also be found in the scrotum. The hernia typically contains either fat from within the belly or even intestines.

Inguinal hernia and hydroceles occur in up to 5% of children. They are more common in premature infants and in boys.

What is a hydrocele?

A hydrocele (hi-dro-seel) is a fluid filled sac in the groin or scrotum. Hydroceles have similar physical exam findings as an inguinal hernia but no intestine or tissue is found within the sac. The hydrocele may connect to the belly (communicating hydrocele) or have no connection (non-communicating hydrocele).

What causes inguinal hernias/hydroceles?

Before birth, the testicles form behind the belly wall and go down through an opening in the groin muscle to get to the scrotum. As the testicle passes through the groin muscle, the testicle pulls the lining of the belly wall through an opening in the groin muscle and down into the scrotum, forming a sac. When the testicle stops in the scrotum the body is supposed to close the sac. In some children the sac does not close and either intestine or fluid can go down into the sac. Intestine going into the sac is a hernia while fluid going into the sac is a hydrocele. In boys a hernia or hydrocele can cause swelling in either the lower groin or the scrotum.

While girls don’t have a testicle that drops they still have the muscle opening and can develop a similar sac. For girls, swelling due to a hernia occurs in the groin, pubic area, lower abdomen, or labia. In girls the sac can be filled with intestine, fluid, or even the ovary.

How is it diagnosed?

Inguinal hernias/hydroceles are usually diagnosed by physical review alone. Rarely, imaging such as an ultrasound is needed to make the diagnosis.

Inguinal hernias are more noticeable when a child is crying or straining and are less noticeable when a child is relaxed.

How should I care for my child?

No special care is needed for an inguinal hernia. Your child can participate in all normal activities. It is not necessary to put anything over the hernia or do anything to try to keep it in or make it smaller.

When should I go to the ER?

If a child has an inguinal hernia the bowel that goes into the hernia sac can get trapped and kink. When this happens the child can have pain, sudden tender swelling, be fussy or uncomfortable, and may vomit. The hernia may look larger than before. If you notice that the hernia is firmer, redder, or tender your child should be seen by a provider immediately. Fortunately, this is rare.

Do all hydroceles need to be repaired?

No. If there is only fluid in the scrotum of a baby the baby may have a small hydrocele. Most of these close on their own. If the hydrocele is still present by twelve months of age it likely will not go away and surgery is needed. A hydrocele that changes in size over the day or comes and goes is called a communicating hydrocele. Communicating hydroceles do not close on their own and need surgery.

What is inguinal hernia repair?

Inguinal hernia repair is the surgery to fix an inguinal hernia. It is a same-day surgery meaning your child will go home on the same day as the surgery. The surgery requires anesthesia. Some very young infants may need to stay overnight for observation after general anesthesia. There are two different types of inguinal hernia repair:

1. Open inguinal hernia repair

A small incision is made in the groin and the sac is removed from the surrounding tissues. Then, the sac is stitched shut. The incision is closed with dissolvable stitches and is covered with either tape or glue.

2. Laparoscopic inguinal hernia repair

A camera is inserted through the belly button, a small cut is made in the skin on the left side of the belly, and the inguinal hernia is repaired with small needles. 

  • Benefits: Closing the inguinal hernia lowers the chance of organs in the belly getting stuck in the hole in the muscle. The hernia is not able to get bigger as the child grows.
  • Risks: Bleeding, infection, fluid under the incision.
  • Long term outcomes: Children with inguinal hernias have good outcomes and rarely do the hernias come back.

What can I expect after the surgery?

  • Diet: Most children are able to eat a normal diet.
  • Activity: There are no activity restrictions after the surgery. Your child may return to normal activities as they tolerate.
  • Wound care: Your child’s surgeon will give you specific wound care instructions following the surgery. Your child might have a bandage over their belly button for a few days after the surgery that you will remove at home. There might be glue or tapes over the groin incision. Your child can shower within 2-3 days of surgery but you may want to wait 5-7 days after surgery before soaking the wound.
  • Medicines: Medication for pain such as acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®) or something like a narcotic may be needed to help with pain for a few days after surgery.
  • Return to school/daycare: Your child may return to school or daycare when you feel it is appropriate.
  • What to call the doctor for: Fever over 101 °F, wound redness, and/or drainage might indicate an infection. You should contact your child’s doctor if your child develops these after surgery.
  • Follow-up care: Follow-up with your child’s surgeon as needed for questions/concerns. You can call (612) 813-8000 to schedule an appointment.

Questions?

This information is not specific to your child but provides general information. If you have any questions, please call your clinic.

Reviewed 9/2019

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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