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A hernia is an opening or passageway where there shouldn’t be one in the body. In most cases a hernia will look like a bump or lump on the skin. This protrusion is caused by tissue or an organ pushing through the opening or weakness in the muscle wall that contains it, known as a hernia.
In adults, hernias are often caused by injury to a muscle, but hernias in children are usually a condition they’re born with. The most common locations for hernias in children are in the groin region (inguinal hernia), the belly button region (umbilical hernia) or the abdomen above belly button (epigastric hernia).
With the exception of umbilical hernias, which can close on their own in the first 3-5 years of life, most hernias will not go away without surgery. In general, unless the hernia is expected to close on its own, as determined by a physician, a surgical repair is recommended so that no tissue or organ gets stuck inside the hernia. When tissue or an organ gets stuck, it is called an incarcerated hernia. In rare cases this can require immediate medical attention, such as with groin hernias, in which a portion of the intestine can get stuck, causing bowel obstruction and compromised blood flow to that piece of intestine.
Lurie Children’s physician-surgeons can treat all types of pediatric hernias through minimally invasive surgical procedures.
Learn more about the different types of pediatric hernias, and how they’re treated, below.
Inguinal hernias are the most common types of hernias in children. When babies are in the womb, there is a passageway (known as the processus vaginalis) between the abdomen and groin region. Typically, the passageway closes as the fetus develops and is gone by the time a baby is born, but if it remains open, it can lead to an inguinal hernia. These are more common in premature babies because there is less time for the passageway to close.
The diagnoses of inguinal hernia and hydrocele are closely related and involve a very similar operative repair. A hernia occurs when the passageway remains wide open after birth. A hydrocele occurs when the passageway closely mostly, or completely, but traps some fluid in a sac around the testicle. You’re surgeon will be able to distinguish between these two conditions.
Inguinal hernias are different in adults, when they are often caused by overuse of a particular muscle. In babies and children, the hernias are naturally occurring and unpreventable.
What are the symptoms of inguinal hernia?
Most of the time symptoms of an inguinal hernia include the appearance of a protrusion in the groin area. For most patients, it appears as a protrusion with no other symptoms. It can become more visible when a child is crying, yelling or straining and it may disappear completely when the child is resting. It can cause some pain and tenderness in the area of the hernia, but for most children with this type of hernia, there is no pain.
Rarely, children may have symptoms of abdominal pain, vomiting or difficulty stooling because of intestine trapped in the hernia. Any of these symptoms would require a more urgent evaluation.
What is the treatment for inguinal hernia?
There are different ways to repair an inguinal hernia in a child. Your Lurie Children’s surgeon will talk to you about the recommended approach depending upon the child’s needs.
For premature babies born with hernia, it is usually best to repair the hernia within a couple of weeks of its discovery to avoid risk of hernia incarceration. For older children with no symptoms, the urgency to repair is minimal, but often still recommended to avoid any obstruction, and surgery can be scheduled at the family’s convenience.
One common way to fix an inguinal hernia is through an open repair where a small incision is made at the site of the hernia. The hernia is closed with a suture. Another way to close it laparoscopically, where surgeons place a small camera through the belly button and pass a suture to close the hernia through a small hole.
Generally, inguinal hernia repair is a 1-2 hour outpatient operation under general anesthesia and the child will go home the same day. Most children return to all activities within a couple of days.
Complications following inguinal hernia surgery are rare. As with any surgery, there is a small risk of bleeding, bruising and infection. There is a small risk of a hernia coming back and a very small risk of injury to the testicle.
In rare cases, a loop of intestine can get trapped inside a hernia. This is called an incarcerated hernia and may require emergency surgery. Symptoms of this include a tender and firm mass at the site of the hernia and it can be associated with vomiting and fussiness. This occurs most commonly in premature babies within the few months of life and is extremely rare in older children. It is important babies with these symptoms get immediate medical attention.
For older children (adolescents) presenting with hernia, Lurie Children’s offers a unique approach in which surgeons can determine whether the hernia is something that has been present since birth or may have been caused by an injury or weakness in the muscle. For these patients, surgeons can use a camera to see which type of hernia it is. If the muscle is weak, they use a minimally invasive (robotic) approach using mesh to help repair/reinforce the muscle. The mesh remains indefinitely and grows with the child. This type of approach is used only in teenage patients.
An umbilical hernia is a hernia occurring at the belly button. It is often identified by the appearance of an “outie” belly button. When a baby is in the womb utero, the umbilical cord passes through the belly button into the abdomen. After the umbilical cord is cut following birth, the body will usually naturally close that hole within a couple weeks following birth. In some cases, this type of hernia will close over several years, leaving a little skin behind for a permanent “outie” belly button.
It is rare for there to be complications associated with this type of hernia. Physician-surgeons rarely recommend surgical repair of this type of hernia before age three, unless the child has significant symptoms, and the hernia appears to be getting larger.
Umbilical hernia repair involves a child being under general anesthesia before a surgeon makes a small incision in the crease of the belly button. The surgeon closes the hole in the tissue with dissolvable stitches. The child is typically home the same day of the procedure, which lasts about one hour.
As part of hernia repair, the outward appearance of belly button will become more of a typical “innie,” although the final appearance of the belly button following the procedure will vary.
Complications following umbilical hernia surgery are rare. As with any surgery, there is a small risk of bleeding, bruising and infection. There is a small risk of a hernia coming back.
The third most common type of hernia in children is an epigastric hernia. This usually appears as a painless lump in the middle of the abdomen above the belly button.
These often appear in first few years of life and rarely cause symptoms. As with other hernias, this occurs because there is a hole in the tissue below the skin. The bump appears because fat inside the abdomen protrudes to the outside.
Repairs for epigastric hernia are more elective than repairs for inguinal and umbilical hernias because there are rarely symptoms or complications. Lurie Children’s surgical experts recommend meeting with a pediatric surgeon to discuss the pros and cons of a surgical repair of an epigastric hernia.
If surgery is recommended, the hernia is closed through a small incision with dissolvable stiches, and the patient typically goes home the same day.