Repair of inguinal hernia (herniotomy)

What is an inguinal (groin) hernia?

Some of the contents of the tummy protrude into a sac or tube forming a lump in the groin.

In boys the lump often extends in to the scrotum. Often the hernia will contain a bit of bowel but in girls may contain the ovary.

The hernia happens because of a persisting sac coming from the tummy. Most of these sacs close by the time a baby is born but if they do not then a hernia can develop. There is no weakness in the wall of the groin like there is often in adults. Hernias can occur in all ages of babies and children and are more common in boys than girls.

What would happen if nothing was done?

Hernias can be uncomfortable and do not go away. A hernia becoming stuck is much more common in babies.

If the hernia contains bowel this may become stuck and lead to bowel or testicle damage in boys, and ovary damage in girls.

What does the operation involve?

There are 2 main hernia operations. One uses a cut in the groin (called open surgery) and the other uses a camera telescope put in through the tummy button and small instruments put in to the tummy through tiny cuts (keyhole or laparoscopic surgery).

Your surgeon will discuss which operation they feel is best for your child. There are advantages and disadvantages for both types of surgery.

With either approach a general anaesthetic is used. Any tummy contents are returned to where they are supposed to be and the sac is found and tied off.

The operation is usually done as a day case, meaning you will be in and out of hospital on the same day. Young babies may have to stay overnight to make sure they have recovered fully before they go home.

All the cuts are closed with dissolving stitches buried under the skin or a special skin glue.

What complications can occur from the surgery?

Complications are uncommon following this operation.

In boys the hernia sac is very close to the testicular blood vessels and the tube which carries the sperm (the vas). In 1 in 100 or 1 in 200 operations these structures can be damaged during the operation. Damaging the blood vessels may mean that the testicle does not grow and may shrink away. Damaging the vas tube carrying sperm may affect fertility of the testicle later.

In 1 in 100 operations in boys the testicle can get caught in scar tissue from the operation and pulled back into the groin. This may need another operation to move the testicle back down again.

There is a risk of the hernia coming back again (recurrence). This risk is higher in very small babies with very big hernias. The overall risk is still low however at about 1 in 100.

There is a risk of a wound infection (about 1 in 50) that would need to be treated with antibiotics.

There is also a potential risk of a hernia on the other side later on. This risk is higher is girls.

Despite this list the risks of operation should be less than the risk of complications if the hernia was left alone.

How do babies with hernias differ from older children?

Hernias are more likely to cause problems (especially becoming stuck) in babies and infants. Because of the repairing the hernia is more urgent in this age group.

Complications from the operation are also more likely in this age group because of the delicate structures, particularly in boys. In young babies swelling and bruising of the scrotum is quite common whilst it is unusual in older boys.

What will it be like after the operation?

Recovery from the operation is usually very quick, especially in babies, infants and young children.

Food and drinks are usually allowed as soon as your child has woken up.

The area will be sore for a couple of days but children are usually back to normal activity within a few days. Regular paracetamol and ibuprofen are useful.

There may be dressing on the wound. Instructions about what to do with this will be given by your doctor or nurse.

Your child can go back to swimming after a week. In older children it is best to keep them off games, PE and sports for 2 weeks.

Will there need to be any medical check up after the operation?

Usually no clinic visit or check up is needed. Sometimes we do need to see babies and young infants again, and your doctor will let you know if this is the case.