The hernia is a common reason for surgery in adults and most of us have heard about it. However, it may surprise us that hernia and hydrocele are also common in children. The cause and its treatment are slightly different from that of adults. The parents should not get worried about this condition, as surgical treatment of this condition is universally successful.
Consider these figures…
· 20 million Groin Hernias are repaired annually worldwide
· 80% of all Inguinal Hernias occur in males
· 85% of all Femoral Hernias occur in females
· Approx 670,000 Inguinal Hernia repairs are performed annually in the US
· Most Hernias occur in males, with a male to female ratio of 6:1. Correct recognition and initiation of the proper therapeutic route is essential for an excellent outcome, which should approach optimum success
· Hernias occur in 1% to 4% of all infants. The incidence may reach 30% in premature infants depending on the child’s gestational age at birth. One-third of all children with Hernias present before six months of age.
Causes, Symptoms & Other Factors…
Swelling in the Groin area is a common problem in children. It can be a painless swelling or painful swelling. They both can come on suddenly and develop slowly over time. Painful swelling is less common than painless swelling but is usually more serious, especially if it is severe and sudden. If a child has scrotal swelling at any age, one must see a doctor. Most scrotal swelling is not painful but still needs to be evaluated. If a child has pain from an injury to the testicles that lasts longer than an hour, one must see the doctor. In case, if there is a painful scrotal swelling that starts suddenly – this is a medical emergency.
Hernias and Hydroceles are the most common causes of scrotal swelling. They are caused by abnormal openings left behind when the testicles descend into the scrotum during development. Hydroceles are collections of fluid that pass down into the scrotum and are present in about 10 per cent of baby boys at birth. If an opening does not close by itself, a portion of the intestine may pass through the opening. This is called a Hernia. The Hernias occur in about 1 to 5 % of all newborns and are more common in premature babies. The treatment is waiting till 1-2 years of age for Hydrocele, whereas the Hernia needs immediate surgery.
Prevalence and Incidence…
In India, due to the limited paediatric surgical services available, the majority of the patients with Indirect Inguinal Hernia is managed by general surgeons. In a hospital in Delhi, Inguinal Hernias constituted 12.5% of all surgical procedures. Most of the children were over 1 year of age and only the symptomatic Inguinal Hernias were operated upon. Due to the high risk of incarceration in premature babies, a careful search for the presence of Inguinal Hernia is recommended.
Inguinal Hernia is one of the most common surgical conditions globally. An estimated 20 million Groin Hernias are repaired annually worldwide. Despite the high disease prevalence, relatively few studies of Inguinal Hernia epidemiology have been undertaken. A study from the UK found a 27 per cent lifetime risk for Inguinal Hernia repair in men and 3 per cent in women. Studies of groin hernia incidence are particularly limited. Data from the NHANES study have been used to make the most reliable assessment of Inguinal Hernia incidence in the US.
The annual Inguinal Hernia repair rate in the United Kingdom (130 per 100,000 population) is lower than the rate of repair in the US. Differing practice patterns among surgeons and referring primary care physicians may explain regional differences in the incidence.
In India, the services of paediatric surgeons are available only to a limited extent and are restricted at present to the major cities. And Inguinal Hernia repair in children is still one of the commonest procedures performed by paediatric or general surgeons. The peak incidence of Hernia is seen during the 1st month when one-third of children present within 6 months of age, and boys are affected 6 to 10 times more often than girls.
Hernias are a common disorder in the general population and may be more prevalent in children. Prompt surgical intervention is essential to prevent therapeutic implications and lifelong consequences. Regular screening and assessment of Inguinal Hernia among young children are important, particularly among infants aged less than 6 months and preschoolers. Moreover, early screening of inguinal hernia for children who were born prematurely, particularly within 6 months after birth, is crucial for Hernia repair.
About the Author…
Dr. Shandip Kumar Sinha is a Paediatric Surgeon and Urologist, who has a special interest in Minimally Invasive Paediatric Surgery, Paediatric Endourology and Reconstructive Paediatric Urology. He practices at Madhukar Rainbow Children Hospital, Malviya Nagar, Delhi as a Senior Consultant Paediatric Surgeon. He is an MBBS, MS and M.Ch (Pediatric Surgery). He is a former Professor (Paediatric Surgery) at Maulana Azad Medical College. He was also associated with LNJP and GB Pant Hospitals.