As you know, instead of the information you can easily find everywhere, I prepare more special blogs to answer your questions. But this time, in order to explain the answer, I need to explain what the problem is. In the journal of the paediatric surgeon this week, I will give information about what is inguinal hernia and hydrocele in children.
Inguinal hernia can be seen at a rate of about 1-5% in newborn babies. In case of premature birth, this rate can rise to 10%. As the weight falls, the incidence of hernia increases.
In general, it is 3-4 times more common in boys than girls and, although it is mostly seen on the right side, it can be bilateral up to 10% in normal newborns and 50% in preterm babies.
But why does inguinal hernia happen in children?
In our abdomen, there is a membrane called “peritoneum” around our organs. While the baby is in the mother’s womb, the testicles begin to descend from the side of the kidney, pass through the inguinal canal and settle into the place where they should be in the scrotal sac. During this descending process, the peritoneum extends like a finger, enters through the inguinal canal with the testicle and extends downward. Normally, this extension, which we call “processus vaginalis”, closes and disappears with birth. If it remains open as, one day when the babies are straining, pushing, crying, that is, when they increase the intra-abdominal pressure, the intra-abdominal organs enter through this opening and we see this as a swelling in the groin. This condition, which we call inguinal hernia, can also be seen in girls. Girls do not have testicles, but the ligaments and other formations that keep the uterus tilted forward develop in the same way, while the peritoneal membrane stretches down like a glove finger. If this stretched canal remains open, an inguinal hernia, which is seen as swelling in the groin, occurs with the penetration of organs into it, just like in boys.
If the opening of this channel is too narrow for the bowel to pass but is wide enough for fluid to pass, we call it a “connected hydrocele”. It is called “water hernia” among the people. We consider it like a normal hernia.
What we encounter more frequently in babies is the “disconnected hydrocele”, which is manifested by the closure of the connection between the canal and the abdomen, and only the accumulation of fluid in the canal. You know, newborn babies’ scrotum look very swollen and edematous, here is the hydrocele without the connection of swelling. If the disconnected hydrocele is located a little higher than the testis, we call it “cord cyst” or “cord hydrocele”. Similarly, the cyst in the groin in girls is called the “Nuck Canal cyst”. Almost most of these formations spontaneously disappear within the first 2 years. If they do not pass, they are thought to have a connection with the abdomen and they are corrected surgically by Dr. Egemen 🙂  I will write how we did it in another blog.
When organs such as the intestines, omentum or ovaries in girls pass through this opening and can not turn back into the abdomen, it is popularly known as strangulated hernia. It can be seen at a rate of about 15-30%. And this situation occurs usually in the first year after birth. 85% of all strangulated hernias occur in the first year. The importance of this is that, it is not the right to expect growth after the diagnosis of hernia in babies.
What are we doing in treatment?
In order to prevent the organs in the abdomen from entering and leaving the canal, we close the opening I just mentioned. I will explain how we will choose which surgical technique, either open surgery or laparoscopy, in the next blog.
When should we operate?
First of all, if there is no strangulation, there is no need to do emergency surgery. Even if there is a strangulation, the first thing we do is try to push back the organs that are stuck outside to the inside of abdomen. If we cannot do it, and if there are other findings such as bilious vomiting and abdominal distension in the child, we need to perform emergency surgery. If we could push back in, we usually lay it down and wait for the resolution of the edema in that area for 24-48 hours and then take it into operation. By doing this, the recurrence rate becomes much less.
What if there is a hernia that is not strangulated and asymptomatic?
We don’t know when we will face an emergency? Maybe after 2 days the hernia will strangulate, it will be necessary to run in to emergencies at midnight, maybe it will not cause ant problem until the end of his life. In a study conducted in Canada, it was found that the frequency of hernias strangulation increased by 7% 14 days after the diagnosis of hernia in children younger than one year old. In other words, although there is no need for an emergency after the hernia is diagnosed, it is still recommended to perform the surgery within the first 14 days.
We have come to the end of another course. In the next course, I will explain the choosing of technique to operate the inguinal hernia, and whether I need to operate on one side, if any, on the other.
I explained these on my youtube channel. . Please follow us on instagram. 
If you want you can watch these on my youtube channel by clickin here.  Please follow us on instagram.
And stay happy.
Prof. Dr. Egemen Eroğlu
April, 2021