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Help, there is a swelling over my son's groin!
Your son should be examined by a paediatrician or a paediatric surgeon. There are several different diagnoses that are possible for example, inguinal hernia, hydrocele, inguinal lymph node, tumor, etc. A good clinical examination suffices to reach a diagnosis. Sometimes an ultrasound is needed to diagnose the cause of the swelling.
Is an inguinal hernia dangerous?
It can cause an intestinal obstruction and the risk is highest in infancy. A hernia is a protrusion of an organ through a weakness in the tummy’s muscle wall. This is because of a patent opening and tract that extends from the tummy to the groin and to the scrotum. This patent tract can have a small opening which a loop of small intestine may become stuck. The blood vessels supplying the small intestine is progressively constricted as the intestine swells. In prolonged and acute obstruction, the loop of the small intestine may die because of the lack of blood supply.
Can medicines cure an inguinal hernia?
Unfortunately, no medicine can close the opening and weakness in the tummy’s muscle wall. Only surgery can repair the anatomical defect.
When is the best time to repair an inguinal hernia?
The repair of an inguinal hernia in a baby or child or teenager is time sensitive, and should be performed as soon as the baby is fit for surgery. This is because of the risk of obstruction and subsequent strangulation of intestine due to the hernia.
What happens during an inguinal hernia repair / herniotomy?
During discussion with your doctor, a laparoscopy (keyhole procedure) may be advised to visualize both inguinal openings. This is because there is a proportion (8 – 20%) of patients who have a concurrent patent opening and tract on the other side of the tummy, but have not manifested as a hernia yet (Reference, Staerkle, 2020). A laparoscopic herniotomy can be performed if there is bilateral hernias. The patient is put under general anaesthesia and keyhole incisions are made to insert the laparoscopic instruments. The opening(s) in the tummy is then repaired. The laparoscopic instruments are removed and the wounds are closed with absorbable stitches.
If there are reasons against a laparoscopic hernia repair, the operation can be performed via an open technique (Reference: Esposito, 2012). The patient is put under general or regional anaesthesia. A groin skin incision is made, the opening and tract are repaired. The wound is closed with absorbable stitches. Local anaesthesia is given in both techniques to ensure a painless recovery.
Both techniques are day surgeries, and the patient can go home on the same day.
How is the recovery after an inguinal hernia repair / herniotomy?
Minimal bleeding is expected from the wound. This is a clean surgery and oral or topical antibiotics is not required. The patient can have normal baths. Painkillers may be required for the first 2 to 3 days. In babies, it is adviseable to change the diapers 2 to 3 hourly to keep the wound clean. A scab forms over the wound normally in the first 2 weeks and drops off with time. Some swelling may occur in the scrotum or genitalia after surgery and is the normal body reaction after surgery. This resolves after 4 to 6 weeks. Risks of the surgery are infection, recurrent hernia, damage to the testis, ascending testis and repeat surgery. Infection presents as redness, swelling, pain, warmth and abnormal discharge of the wound site(s). If any of these complications occur, treatment is available and your doctor should be consulted early. It is important to avoid swimming and exercise for 4 weeks to allow the wound to have good healing and strength.
Staerkle RF, Guglielmetti LC, Bielicki IN, Gaukel S, Frongia G, Hilton S, Fink L, Vuille-Dit-Bille RN. Is it worth to explore the contralateral side in unilateral childhood inguinal hernia?: A PRISMA-compliant meta-analysis. Medicine (Baltimore). 2020 Jul 31;99(31):e21501. doi: 10.1097/MD.0000000000021501. PMID: 32756186; PMCID: PMC7402905.
Esposito C, Giurin I, Alicchio F, Farina A, Iaquinto M, Scermino S, Palladino T, Settimi A. Unilateral inguinal hernia: laparoscopic or inguinal approach. Decision making strategy: a prospective study. Eur J Pediatr. 2012 Jun;171(6):989-91. doi: 10.1007/s00431-012-1698-4. Epub 2012 Feb 17. PMID: 22350286.
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