Inguinal hernia is the protrusion of abdominal organs (usually intestines) into the inguinal canal or scrotum due to a weakness in the groin area. It is one of the most common surgical problems in children. This condition occurs during the formation of the inguinal canal in the womb but symptoms often appear later in life.

Inguinal hernia is more common in male children. Among all newborns, approximately 1-5% have inguinal hernia. The incidence is lower in female children. In premature babies, this incidence increases to over 10%. Additionally, children who show signs of inguinal hernia on one side have a high chance of having an asymptomatic hernia on the other side. The advantage of laparoscopic surgery is that without making an additional incision, the entire abdominal cavity can be visualized, allowing detection and treatment of an asymptomatic hernia on the opposite side in the same session.

Types

Inguinal hernias can be classified into two main types. The first is direct inguinal hernia, more common in adults. The second type, indirect inguinal hernias, accounts for over 99% of hernias in children. Due to the anatomy of the disease, intestines entering the inguinal canal descend into the scrotum surrounding the testes in boys, causing a large swelling in the groin. This can be alarming for families. Early diagnosis and treatment usually prevent problems in children. However, if the blood supply to the intestines inside the hernia is compromised, life-threatening problems may occur.

Symptoms

Most children with inguinal hernia are diagnosed when parents notice swelling in the groin. As mentioned, in boys, the swelling may extend into the scrotal sac around the testes. The swelling usually becomes more pronounced with coughing or crying and returns to normal when the child calms down. However, if the swelling does not reduce after such episodes, intestines in boys, and intestines or ovaries in girls may become trapped. This incarceration can cause bowel obstruction, compromised blood supply to intestines, ovarian ischemia in girls, and gangrene—serious, life-threatening complications. For these reasons, inguinal hernias should be surgically treated before such complications develop.

Diagnosis

Inguinal hernia diagnosis is made by a pediatric surgeon’s physical examination. Hernia should be the first suspicion in children presenting with groin swelling. Other causes of groin swelling include:

• Undescended testis,
• Hydrocele (fluid accumulation around the testis),
• Lymphadenopathy,
• Cord cyst.

All these conditions require pediatric surgical evaluation and treatment. Therefore, if a child has swelling in the groin, they should see a pediatric surgeon without delay. Diagnosis is mainly clinical, and experienced pediatric surgeons differentiate these conditions. Ultrasound is rarely needed.

Treatment

The only treatment is surgery. Previously used methods like trusses and corsets increased complication risks and did not help healing. Therefore, for about 150 years, surgery has been the sole effective treatment.

Nowadays, inguinal hernia surgery is performed laparoscopically in some centers. Families should choose centers that perform laparoscopic (minimally invasive) surgery because of its postoperative advantages:

• Faster recovery,
• Lower risk of infection,
• Better cosmetic results.

The greatest advantage is the ability to evaluate the other side during surgery and treat an asymptomatic hernia in the same session, preventing future surgeries and anesthesia. Postoperative complications like bleeding, swelling, and damage to spermatic ducts are much rarer in laparoscopic surgery. The recurrence rate is very low (<1%) in experienced centers, both in open and laparoscopic surgery.

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