What is an inguinal hernia?
Unlike inguinal (groin) hernias in adults, it is not caused by straining, heavy lifting or "old age." Instead, it is a defect that has been present since birth: a small hole in the abdominal wall, through which the spermatic cord (in boys) or the ovarian ligament (in girls) passes, failed to close. As a result, abdominal contents (sometimes a loop of bowel, or the ovary; and sometimes, just fluid) can slip through that hole, into the groin or the scrotum.
When the loop of bowel or the ovary gets stuck in the hole, the hernia is incarcerated. If the hernia is incarcerated, and the blood vessels to the loop of bowel are compressed, that piece of bowel may die off: the hernia is now strangulated.
Why does an inguinal hernia have to be fixed?
Inguinal hernias should be fixed to avoid incarceration and strangulation. This 'hole' in the abdominal wall (patent processus vaginalis is the medical term) has been present since birth, and will not close on its own. Therefore, it is recommended to have it fixed as soon as it is diagnosed; waiting months or years only increases the risk of a complication.
What needs to be done before the operation?
Unless your child has a medical condition that requires it, no preoperative testing is necessary: no blood test, no X-ray, no urine test. Simply, you will be asked to visit the operating suite a few days before, for about an hour. During this 'POP' (Preoperative Program), you will meet the operating room staff and the anesthesiologist (the doctor who will put your child to sleep), so that you can ask them questions (they may have some questions for you, too). Meanwhile, your child will familiarize him- or herself with the operating room environment, so that he/she will be less nervous the day of surgery.
One (business) day before surgery, you will be told at what time to come in for the operation. Your child will need to be without food or drink for several hours before the planned time of operation. Please follow the instructions closely; if your child does not have an empty stomach, anesthesia and surgery may be more risky.
What happens during and after surgery?
The operation itself lasts about 30 minutes, and is done under general anesthesia. At the end of the operation, your child will be transported to the recovery room. Once everything is settled, someone will bring you to your child, so that you can be there as he/she wakes up. Once your child is fully awake, and can tolerate food (or at least something to drink), you will be allowed to go home. The stay in the recovery room should be about one to two hours.
What happens when we get home?
Your child may not be very active following the operation. In fact, he/she may be nauseous, and even vomit a few times. This is usually a result of the anesthesia, and is short-lived: it should be gone by the next morning. In the meantime, make sure your child is at least able to drink clear liquids, to avoid dehydration. An electrolyte solution if your child is young (under one year), or any clear liquids (apple juice, broth, etc.) will do.
Your child should be much better by the next morning, and no further restriction of activities is necessary. He/she can go back to school or day care. Although there is no risk of tearing or rupturing anything, any type of straddling activity (rocking horse, tricycle, bike) should probably be avoided for a few days.
How do I care for the incision?
The incision in the groin is about one inch wide, in a skin crease. It is sutured with an absorbable suture: this suture will dissolve in a week or two, and will not have to be removed. The area is also covered with a plastic film (collodion), which keeps the area somewhat waterproof. The plastic layer will peel off in about a week.
Still, it is better not to give your child a bath for about three to four days (sponge-bathing is better).
What's normal and what's not?
Vomiting: May be very disturbing, but will be short-lived: It will be over by the next morning. If your child vomits everything (including liquids), and is very young (under a year), however, dehydration may be a concern. If your child has one or two wet diapers that evening, and is otherwise cheerful and playful, you shouldn't worry. If you're not sure, call us.
Fever: A low-grade fever may be seen the first evening or night; after that, any fever (particularly 101 or more) is abnormal, and you should call us.
Wound problems: There may be some mild redness at the wound, but this should improve within a day or two. There may also be a drop or two of clear fluid. If the redness gets worse, or the wound starts to drain more fluid (particularly if it is cloudy or bloody), you should call us.
Pain: Your child will have surprisingly little pain beyond the first one to two days after the operation. If your child is older than one year, you received a prescription for acetaminophen with codeine; give him/her the prescribed dose, as often as every four hours. After 48 hours, plain acetaminophen will be sufficient.
If your child is under one year, do not give codeine; rather, give plain acetaminophen as needed (as often as every four hours).