Treatment

If a hernia is diagnosed then the child should have surgery as soon as is convenient although the timing of operative intervention is controversial (see notes).. A herniotomy is performed - the patent part of the processus is isolated and tied off at the internal ring and then the distal part is excised.

If there is evidence or possibility of obstruction then the child requires urgent surgical review.

Notes:

• often an inguinal hernia has an associated hydrocele. This may be difficult to distinguish from an incarcerated hernia and if there is doubt then exploration is indicated
• unfortunately, some children develop an incarcerated hernia while awaiting a scheduled operation, or even prior to diagnosis
  • there is controversy regarding the best timing for hernia repair, and the practice of delaying surgery in infants is still common
    • delaying of operative intervention ncreases the risk of incarceration
      • incidence of incarceration ranges from 9% to 31%, and the majority of cases occur in children under 1 year of age
      • in one study (1), 9.7% of the children presented with incarcerated hernia, and 53% of all incarcerations occurred in children under 1 year of age. More than half of them (52.9%) were known to have inguinal hernia prior to incarceration

Reference:

1. Niedzielski J et al. Could incarceration of inguinal hernia in children be prevented? . Med Sci Monit. 2003 Jan;9(1):CR16-8