I'd like to ask the folks in Yongzhou, Hunan Province. What should I do if my child has a hernia?

People often say pediatric hernia in clinical medicine called extra-abdominal hernia, it is the abdominal organs (mainly intestinal tubes) through the abdominal wall potential pipe or defect to the abdominal wall outside the protrusion of the clinical manifestations. Pediatric hernias are subdivided into congenital and acquired hernias. Congenital hernias include umbilical hernias (umbilical enlargement localized outward protrusion, up and down with breathing), inguinal hernias, and white line hernias. Acquired hernias include inguinal hernias and abdominal wall incisional hernias. Clinically, we often see children who have recurred after local surgical treatment for hernia or who have developed medical cryptorchidism after surgical treatment for hernia. There is a difference between pediatric and adult hernias, and the treatment of pediatric hernias is completely different from the treatment of adult hernias. Acquired hernia is because the abdominal wall of the child is not yet well developed, the child cried when the intra-abdominal pressure suddenly increased due to.

(2) pediatric inguinal hernia is easy to incarcerate, but because of the weak abdominal wall of the child if found in a timely manner (generally within 12 hours) is easy to manipulate the reset success. Because of pediatric intestinal flexibility, even if the hernia contents of the incarcerated rarely occur intestinal strangulation and intestinal necrosis.

(3) because the pediatric inguinal canal is still developing, therefore, its various components of the wall structure is weak, the lumen straight (from the back vertical forward) short about 2-3 centimeters.

Therefore, special attention should be paid to the following points in the treatment of pediatric hernia:

(1)The best time for pediatric hernia surgery is between half a year and one year of age.

(2) When hernia surgery is performed on a pediatric patient younger than 3 years of age, it is not advisable to open the inguinal canal as long as the hernia sac is ligated in a high position.

(3)The incision for pediatric hernia surgery takes into account the psychological tolerance of the pediatric patient and the need for aesthetics, and a tiny incision in the direction of the lowest lower abdominal dermatoglyph is often used.

(4) Because pediatric surgery is a newly developed discipline, the primary health care units are technically weak and poorly equipped, and it is easy to misdiagnose the disease, resulting in irreparable consequences, therefore, the author suggests that parents should bring their children to the pediatric surgical specialties of large hospitals in order to avoid medically induced injuries.

Hernia refers to any organ that has been dislodged through a gap or weakness in the wall or cavity of a body cavity to an abnormal place and produces symptoms that can be called "hernia". In children, inguinal hernias, commonly known as "small bowel" hernias, are more common. This is closely related to the descent of the testicles and the sudden atresia of the peritoneal sheath in boys.

※Symptoms The most important symptom of hernia is in the groin area, you can see or feel the lump. The trigger for the appearance of the lump is a rise in abdominal pressure, the most common cause of which is crying, while others include coughing, defecation and urination. In addition to seeing or feeling the lump, some children may experience constipation, loss of appetite, or spitting up, while others may become tearful and restless. A scrotal hernia that is too large can cause mobility problems.

*Nursing care When the child "small bowel gas" attack, parents first comfort the child do not cry, let the child lying down, or gently press the hand mass, often with a "bone" sound, out of the small intestine is back into the abdomen.

Parents must realize that not all "small bowel gas" is a cry that comes when pushed. An incarcerated hernia occurs when too much small bowel has been in the hernia sac for too long, and the neck of the hernia sac tightens so that it can't be retracted. Once the blood supply to the incarcerated small intestine and other organs is affected, making the tissue edema, the child cries more than once due to pain and vomiting and abdominal distension due to intestinal obstruction, then you should go to the hospital immediately for emergency treatment, otherwise it may lead to tissue necrosis, intestinal perforation, and even life-threatening.

Except for a very small number of children with small inguinal hernias that are likely to heal themselves within six months of birth, the vast majority of more or less are more difficult to heal themselves, and surgical treatment is a common method of eradication. The best time to operate on a pediatric inguinal hernia is between the ages of 1 and 2. It can be treated conservatively by using a hernia tray or belt before the age of 1, but if an incarcerated hernia occurs, emergency surgery is needed.

Pediatric hernia

1. Introduction

Pediatric hernia, commonly known as inguinal hernia, is the most common disease in pediatric urologic surgery. During embryonic life, there is an inguinal sheath that helps to anchor the testes to the scrotum or to the round ligament of the uterus. In some children, this sheath closes incompletely after birth, causing the small intestine, omentum, ovaries and fallopian tubes to enter the sheath, which becomes a hernia; if only abdominal fluid enters the scrotum, it is called scrotal edema.

The incidence of hernias is 1-4%, 10 times higher in boys than in girls, and higher in preterm infants, and may occur on both sides.

2. Symptoms

Hernias can occur days, months, or years after birth. Usually, a bulging mass in the groin, sometimes extending to the scrotum or labia, occurs after a child cries, exercises, or defecates; it may disappear on its own after bed rest or sleep. In severe cases, there will be abdominal pain, nausea, vomiting, anorexia or crying.

3. Treatment

Surgery is the best treatment for pediatric hernias. It is usually done with general anesthesia and high ligation, which is safe and does not take long. If a hernia occurs, it is advisable to treat it as soon as possible to prevent the contents of the hernia sac from clamping, which would make surgery more difficult and life-threatening. As for scrotal edema, it can be observed until one year of age, and if it does not disappear, then surgery can be performed; however, careful follow-up is needed to be aware of the possibility of hernia formation.

4. Post-operative precautions

[1] Unless otherwise instructed by the surgeon, the patient should eat and drink as usual after returning home, but should avoid excessive exertion.

[2] If vomiting occurs, fast for four hours.

[3] For pain in the wound, painkillers may be prescribed.

[4] If the wound is bleeding, red, swollen, hot, painful, oozing, or has a high fever, please return to the hospital immediately.

[5] The top layer of the wound is covered with cosmetic tape, gauze and transparent film, while the inner layer is closed with sheep's intestine suture, which is self-absorbing and does not need to be removed.

[6] For four days after surgery, the wound should not be exposed to water. After five days, you can take a shower as usual. After six days, you can carefully remove the transparent membrane and remove the gauze.

[7] If you have any problems, please go back to the hospital immediately.

5. Questions and Answers

Q1. Does a lump in the groin necessarily mean a hernia?

A1:Not necessarily. If you find a lump in the groin, besides hernia, you may also have scrotal edema, varicocele, cryptorchidism, tumor, lymphadenitis or femoral hernia. Detailed examination is required for differential diagnosis.

Q2. Why is the percentage of hernia in boys much higher than that in girls?

A2.In general, the ratio of male to female hernia patients is 9:1, and the reason is related to the testicles. The testes are located in the abdominal cavity during the early fetal period and enter the scrotum from the abdominal cavity during the late fetal period; with the downward movement of the testes, a tubular protrusion called the processus vaginalis is produced in the abdominal cavity; if the processus vaginalis is not yet occluded after the birth of the baby, and the deep abdominal femoral ring is very wide, then the baby's crying may induce a hernia to develop. In addition, there are differences in the arrangement and attachment of the inguinal muscles between boys and girls. The above reasons may lead to a higher percentage of hernias in boys than in girls.

Q3. What is "high ligation"? Will it affect fertility in the future?

A3.Most hernias in children are caused by incomplete occlusion of the syrinx. High ligation is the process of ligating and separating the syrinx in its original position, so that the abdominal cavity is no longer connected to the syrinx, and hernias can no longer occur. If the surgical procedure is normal, it will not affect future fertility.

Q4. How can I tell if my child has a hernia? Does a hernia cause pain?

A4. The most common and typical hernia is a bulging mass found in the abdominal and femoral region, and in some cases, up to the scrotum. Most of these lumps appear after crying, coughing, sneezing, standing for a long time, or strenuous exercise, but they disappear naturally after lying down or resting, and sometimes have to be pressed back in by hand. The pain caused by a simple hernia is usually not very severe, but if there is constant severe pain in the groin and the lump cannot be pressed back, and the symptoms last for two or three days, it may be due to necrosis of the bowel or fallopian tube that has fallen in. This is a very serious complication and may be life threatening.

Q5.If I have a hernia or scrotal edema, when is the appropriate time to operate?

A5.Since hernia is always in danger of clamping, once the diagnosis is confirmed, it is best to undergo surgery as soon as possible; hernia surgery is very safe nowadays due to advances in surgery and anesthesia. As for scrotal edema, if it is not connected to the abdominal cavity, it may disappear on its own before one year of age. Therefore, there is no urgency to operate on scrotal edema during infancy. After one year of age, if the edema has not disappeared, surgery can be performed, but we should keep an eye on it to see if it has turned into a hernia.

Q6. Will a hernia recur after surgery?

A6.The recurrence rate of pediatric hernia surgery is very low. Recurrence is usually caused by too large an internal inguinal ring and high abdominal pressure, such as prolonged constipation or after transventricular peritoneal shunt, which may cause recurrence.

Hernias should generally be treated with surgery to repair them. There is no age limit for surgery, but it is best to operate as soon as possible to avoid an incarcerated hernia; this is especially important for small children because they are prone to having their intestines or abdominal structures (e.g., the greater omentum, the ovaries, the uterus, the bladder,----, etc.) become stuck, as well as not being able to read and write. This, coupled with an inability to express themselves by crying (which increases abdominal pressure), makes the development of an incarcerated hernia more likely to go unnoticed.

Medical Encyclopedia

Non-surgical Treatment

Doctors may give hernia straps to elderly or debilitated patients who are at risk for surgery, which can temporarily prevent the bowel from coming out. A hernia belt is used after the surgeon pushes the bowel back in; it is a pad made of a tough material that is secured to the hernia site with a bandage, which further prevents the abdominal organs from herniating out of the hernia sac. The hernia brace must be worn all day long, and we caution that it may cause skin ulcers, which can be protected by applying a thin layer of powder (e.g., baby powder) to the skin.

Also, it should be emphasized that hernia straps do not absolutely prevent potentially fatal complications (intestinal obstruction), and long-term use may cause skin ulcers and even testicular discomfort and atrophy.

Surgery

Surgery to repair the hernia gap remains the best and most effective treatment. The procedure involves pushing the intestine back into the abdominal cavity and either sewing the gap in the abdominal wall directly, or taking tissue from the side wall to fill the gap, or, if that's not easy, sewing in an artificial mesh. The procedure is different for children and adults.

a. In children, the protruding bowel is pushed back, and the abnormal opening in the abdominal wall is ligated at the opening of the hernia, a procedure known as a high ligation.

b. Adults:

Tissue Suture: This is the more traditional method of sewing up a weak abdominal wall. This procedure is covered by Medicare.

Non-tensioned method: This is a hernia repair using an artificial mesh. The advantages of this procedure are a shorter operation time, faster recovery, lower recurrence rate, and less postoperative pain. The procedure requires only a general or local anesthesia, and the patient can be discharged from the hospital on the day of the surgery or the next day, and can return to his/her normal routine in about a week. However, not all hernias can be repaired with an artificial mesh, depending on the size and shape of the hernia. This repair can be of great value in the elderly or in recurrent hernias. Currently, this procedure is not covered by Medicare.

Endoscopic approach: The newest approach, which uses a laparoscope to enter the abdominal cavity, is more expensive because it requires general anesthesia and the use of an artificial mesh. Because of the immaturity of the surgical method, it is still rarely used at home and abroad, but because of its small wound appearance and quick recovery, it may be well developed in the future.

Medical Encyclopedia

Surgical Procedures and Anesthesia

Adults can be anesthetized with either local, general, or general anesthesia. Most hernia surgeries are performed with general anesthesia, and general anesthesia is required only for more complex hernias. For children, general anesthesia is used and they sleep during the surgery.

Most hernia surgeries can be completed in an hour or two, and usually require a one- to three-day hospital stay, but sometimes, depending on the type of surgery and the patient's condition, the patient may not need to be hospitalized after the surgery and can go home to recuperate. The patient can return to normal life after the stitches are removed in a week.

Post-operative and daily precautions

Post-operative precautions

a. After the operation, you can drink a small amount of boiled water after fully awake from the anesthesia, and then start to eat if there is no vomiting. If there is no vomiting, you can start to eat. If there is vomiting, you should not eat for four hours.

b. In order to prevent anesthesia complications, please breathe y and cough often, and turn over from time to time. If there is phlegm, please cough it out, but remember to hold your hand over the wound when coughing to avoid increasing the pressure in the abdomen or pulling the wound, which can reduce the discomfort.

c. The wound should be kept clean and dry after surgery to avoid infection. If the gauze becomes wet, please tell your healthcare provider to change it for you. Most stitches used to sew wounds are self-absorbent and do not need to be removed; however, depending on the procedure, you should ask your doctor if you need to have the stitches removed.

d. After the surgery, the wound will feel tight and painful, this phenomenon may last for 1-2 weeks, it is normal, the doctor will prescribe painkillers to reduce the pain of the wound.

e. If you are unable to urinate or have not urinated for more than 6-8 hours, you need to tell the nursing staff to deal with the problem because the bladder distension will pull on the wound and cause pain.

f. After surgery, you should lie flat on your back in bed and bend your knees if you want to sit halfway down to avoid increasing abdominal pressure. Usually, you can get out of bed on the day of surgery, but avoid squatting to avoid pulling the wound. If the wound or scrotum is swollen, you need to stay in bed until the swelling disappears.

Daily precautions

a. After discharge, please keep the wound clean and dry, and remember to follow your doctor's instructions to return to the hospital for follow-up.

b. If you find the wound red, swollen, hot and painful, with discharge, odor or bleeding, please return to the hospital as soon as possible.

c.To prevent constipation and increased abdominal pressure during defecation, which can lead to recurrence of hernia, it is important to have a regular life and eat high-fiber foods (such as whole grain bread, pasta, cereal, brown rice, potatoes, beans, fresh fruits and vegetables, etc.) and drink plenty of water.

d. For one month after surgery, you should avoid straining to defecate, sit up, climb stairs, ride bicycles or motorcycles.

e. Avoid strenuous exercise, strenuous work and heavy lifting for three months after surgery.

f. If you have to strain to urinate, please consult the urology clinic to prevent the hernia from recurring due to increased abdominal pressure.

g. If you have a chronic cough, you should go to an internal medicine clinic to prevent a recurrence of the hernia.

h. If a male patient is discharged from the hospital and develops a recurrent hernia or an abnormally enlarged scrotum, he should return to the hospital as soon as possible for treatment.

Thoughtful advice

Remind you! Diseases may have different symptoms

and treatments depending on the individual, and you should seek immediate medical attention if you feel unwell.

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~~Who think so much for you !

The hernia patient should go to that department

You can go to the hospital to see the pediatric surgery, gastroenterology surgery or general surgery to receive surgical treatment Oh.

Insertional hernia:

When a hernia that could be pushed back cannot be pushed back, the bowel or intra-abdominal structures (e.g., the greater omentum, the ovaries, the uterus, the bladder,----) are stuck and protrude into the abdominal cavity. The protruding intestine gets stuck in the opening of the hernia, causing a blockage of the intestine, a phenomenon known as an incarcerated hernia. If the pressure on the bowel is not relieved within one or two hours, the bowel may become necrotic due to ischemia. The patient may experience abdominal distension, nausea, vomiting, abdominal cramps, fever, etc. If the patient is not taken to the hospital for surgery, the condition may worsen to peritonitis and sepsis. An incarcerated hernia, which usually occurs in young children, is a frightening complication of a hernia and can be life-threatening if not treated immediately.

What is an "artificial mesh"

The artificial mesh is made of the same material as surgical sutures and looks like a dense fishnet. Once the mesh is surgically implanted into the body, the body's fibrous tissue will fuse with it and grow into the mesh, eventually forming a strong barrier that prevents the organs in the abdominal cavity from escaping and prevents the hernia from recurring.