Infantile hernia in the groin. Inguinal hernia in children treatment and surgery. Are there effective conservative treatment methods?

The peculiarity of hernioplasty is that it is important for the surgeon to assess the viability of the hernial contents before the start of surgery. If the organs in the strangulation are dead, the doctor resects them during the operation. Hernioplasty is performed on an outpatient basis, the patient’s recovery lasts several hours, after which he will be discharged.

The result of inguinal hernia surgery in children is the restoration of the anatomical structure of organs, blood circulation in the pelvis, elimination of inflammation and developmental risks serious complications. Fatalities during surgery of this type observed in 0.5% of cases.

Prevention

The occurrence of congenital pathologies is very difficult to predict, since external factors may not be at all specific to a particular disease.

Doctors advise parents of newborn babies to undergo regular surgical examinations to check for a predisposition to protrusion of internal organs.

It is also important to monitor the child’s health: perform muscle-strengthening massage, prevent or treat intestinal disorders, monitor normal operation intestines and do not expose the baby to heavy physical labor.

An inguinal hernia, which often manifests itself already in the first year of life, requires timely response from parents, consultation with a surgeon and proper treatment.

If the disease is initial stage, then you can do without surgery, but the advanced form can only be cured by surgery. At an early age, surgery will take place quickly and without complications. According to statistics, pathology is diagnosed less often in girls than in boys.

An inguinal hernia is a pathology that provokes protrusion of the internal organs of the peritoneum under skin through natural openings located in the groin. Children may have many or only one protrusion. Most common reason This is due to the thin structures of the anterior abdominal wall, congenital or acquired factors.

In boys, the presence of a hernia is noticeable if, while walking, he feels discomfort and pain, and swelling appears in the groin.

If your baby is diagnosed with this disease, you need to know what to do in such a situation:

• agree to surgery to prevent complications;
• the disease is dangerous to health, because pinching can occur at any moment;
• in case of injury, hospitalization is urgently needed;
• emergency intervention increases the risk of relapse.

The congenital form in children is oblique. With this form, the logans, following the ring, fall into the groin. A direct hernia is a rare phenomenon; it is characterized by an exit through a defect in the muscle of the external inguinal ring. The hernia can be localized on one side - the right or the left, or both.

In boys in infancy, the pathology is detected with right side(60%). Slightly less often (30%) from the left and only in some patients it is localized on both sides of the groin. Doctors also classify inguinal and inguinoscrotal hernias.

Causes of inguinal hernia in children

During the period of fetal growth inside the mother's womb, together with all other organs, a special canal is formed, which begins to go from the peritoneum towards the groin. At this moment, conditions are formed that will help some of the organs move to the position they need.

It is due to special conditions development of the disease affects the male body. But in female babies main reason manifestations of the disease are improper maturation of the round ligament of the uterus.

But not only abnormal development inside the womb provokes the development of the disease, there are also a number of other factors:

• overweight;
• underdevelopment of the abdominal wall muscles;
• constant loads;
• peritoneal injury.

An inguinal hernia in children (boys) appears due to the fact that developmental anomalies occurred in the womb. The surgeon can diagnose the disease in the first hours after birth. At a certain time, the already mature testicles are located close to the kidneys. When the baby is born, they are sent to the scrotum through a special channel, and at the same time they take away part of the peritoneum.

After this, a pocket gradually begins to form - the vaginal process, which must be completely overgrown before birth. If this process does not heal, the peritoneal organs may prolapse into the lumen. As for girls, the congenital form of the disease is rare in them, because they do not have such a process. The acquired form is diagnosed quite rarely.

After birth, a hernial sac rarely forms. Most often, the diagnosis is made to adolescents of the stronger sex.

There may be several reasons that provoke the development of this disease:

• surgery on the scrotum or internal organs performed in early childhood;
• peritoneal tissues are not developed correctly;
• Excessive exercise – sport involving heavy lifting.

It is possible to visually identify a bulge in the groin, but it is extremely difficult to cure it without surgery.

Symptoms of inguinal hernia in children

An inguinal hernia in children (boys) in the first days after birth and a little older manifests itself in the form of a slight swelling of the skin localized in the groin. Swelling in the scrotum can also indicate its presence. Often the swelling is noticeable only when the baby coughs or cries.

This is why adults often believe that whims are associated specifically with a hernia, but the disease appears in infants due to crying, but there are many reasons for this. Girls are diagnosed with the disease less frequently. In them, the disease occurs when a loop of intestine or ovaries pushes the abdominal wall into the groin, sometimes it can reach the labia majora. This protrusion on the body resembles an oblong cord.

If after the birth of a girl, swelling of the labia is clearly visible, this may be caused by excess fluid or increased levels of hormones received from the mother immediately before birth. This swelling will not harm the baby; it will go away without outside help in a few days.

An inguinal hernia in children (boys and girls) often causes pain in the groin and abdomen. It can radiate to the sacrum or lower back. It is these symptoms that often cause crying and whims in the first year of life. But older children tell adults about pain that occurs in the lower abdomen.

General signs of a hernia:

• loss of appetite;
• vomiting and nausea;
• insomnia;
• diarrhea or constipation;
• discomfort during urination;
• pale skin;
• general weakness and malaise.

Such symptoms should force parents to call an ambulance and consult a pediatrician to prevent complications.

Diagnosis of inguinal hernia in children

You can independently identify an inguinal hernia by examining your child. Or the pediatrician does this during a routine examination of the baby. By palpation it is possible to determine how elastic the protrusion is and whether its structure is soft. If no complications are observed, then the contents of the hernia are easily reduced into the peritoneum.

During this procedure, it is possible to hear a characteristic rumbling, indicating that a loop of intestine has entered the hernial sac. When the reduction has already been carried out, it is possible to feel the inguinal ring with an expanded entrance.

To make an accurate diagnosis, the pediatrician may prescribe a number of additional studies:

• Ultrasound of the abdominal cavity, pelvic organs, inguinal canals and scrotum. With its help, it is possible to determine the contents of the hernial sac, what fluid or intestinal loop it contains, as well as its location. An ultrasound of the pelvis in girls can reveal the characteristics of the hernia and its location.
• Irrigography makes it possible to determine whether there is a protrusion, as well as obstruction in the intestine. The essence of the technique is to take an x-ray of the colon. The procedure is carried out after bowel movement, filling it with a special contrast agent.
• Cystography.

An inguinal hernia in children (boys) requires the surgeon to carry out differentiated diagnostic measures for certain diseases:

• inguinal lymphadenitis;
• hip hernia;
• cryptorchidism, which occurs in male children;
• cyst of the round ligament of the reproductive organ;
• cyst of the spermatic cord and hydrocele in boys.

Only after examination and staging accurate diagnosis the best therapeutic method is selected to help eliminate the disease without relapse.

Prevention of inguinal hernia in children

Watch your weight, don’t gain it and lose it quickly. It is necessary to avoid heavy lifting, extreme strain, excessive stress, and also not to injure the abdominal wall.

Treat in a timely manner ailments that can lead to increased pressure in the peritoneum:

• pathologies of the respiratory system;
• colds;
• constipation;
• problems with urination.

Women, while carrying a baby, should monitor their intestinal function, avoiding constipation. Exercise, but don't overdo it. For newborns, it is important to properly tie the umbilical cord for preventive purposes. Young parents need to learn how to feed their baby correctly and ensure that he does not overeat.

Infants should be placed on their stomachs as often as possible to strengthen the abdominal muscles. The baby should not be swaddled tightly, put in a horizontal position early and thrown up.

Treatment methods for inguinal hernia in children

If even a slight swelling is detected in the groin area, the first thing to do is consult a surgeon. The only method, which will allow you to completely get rid of the disease is an operation. Planned intervention is carried out as quickly as possible.

The timing is different for each child. But as practice shows, the surgeon performs it immediately after diagnosis. But if the hernia can be easily reduced, then surgical intervention can be postponed and wait until the baby is at least 6 months old.

But we must remember that the baby must be under the close supervision of adults and especially a surgeon, so that if the situation worsens, emergency surgery can be performed.

Surgical intervention

Before performing surgery, a small patient needs to be prepared. The safety of the baby depends primarily on the activities. Before removing a hernia, the surgeon must carefully examine the child and assess his health. First of all, at the time of admission to surgery, he should not have any concomitant diseases, for example, a cold.

Therefore, the child must be examined by a pediatrician, who may prescribe a number of procedures:

• pass general analysis blood;
• urine test;
• undergo an examination to identify infectious diseases;
• coagulogram.

Also, the baby must be examined by an anesthesiologist who can accurately select anesthesia. The operation is performed under general anesthesia. The main goal of the surgeon is to remove the inguinal hernia.

• laparoscopy;
• cavity intervention.

Laparoscopy is the latest technique, which is considered less painful and traumatic. Its main advantage is considered to be the complete absence of traces - no scars or scars. During this procedure, the patient is under general anesthesia and the procedure takes no more than an hour. During the operation, the surgeon makes 3 small incisions in the affected area.

Using a laparoscope, the surgeon displays an image of the internal organs of the peritoneum, examining the formation. Subsequently, the hernia is cut off using special instruments. This type of operation is used only at the initial stage of the disease.

In cases where there is infringement of nearby organs, it is recommended to perform open surgery. Open surgery can be performed on children as young as 3 months. The intervention is usually carried out as planned and does not take more than half an hour.

The baby is given general anesthesia, he falls asleep, and the surgeon, strictly following the operation protocol, performs the following manipulations:

1. The surgeon makes an incision with a scalpel in the groin area, its size does not exceed 3 cm. After the operation, not a trace remains of the suture.
2. Next, the hernial sac is separated from the adjacent tissues and all internal organs are returned to their place.
3. Next, the hernial sac is removed and the affected area is bandaged.
4. The incision is sutured using intradermal cosmetic sutures.

Recovery after such an operation is quite fast. Parents of a child who has had an inguinal hernia removed need to ensure the cleanliness of the bandage applied to the suture. It is recommended to change it once a day. If the dressing is performed in a hospital, then you should not ignore going to the hospital.

After laparoscopy, the little patient is discharged on the 3rd day. He can move freely, visit preschool, but here physical activity At first it is better to limit it.

But after open surgery, you will have to wear a bandage for the first 14 days. Take it off only during sleep. Sutures are removed in the first 7 days after surgery. Postoperative sutures It is strictly forbidden to get it wet. If redness or swelling appears, you should urgently seek help from a surgeon or pediatrician.

Traditional methods

If a hernia is strangulated, then use conservative or traditional treatment it is forbidden. In this case, there is only one way out - surgery.

But if there is no infringement yet, and the date of the operation has already been set, then in order to wait for it and alleviate the patient’s condition, You can use the following folk recipes:

1. Inguinal hernia in children (boys and girls) is treated with sour cabbage leaf, which is recommended to be applied to the painful area. The brine in which the cabbage was fermented also helps. The leaf should be warm, and you can heat it in a water bath by placing it in a colander and holding it over steam. If it is brine, then it is slightly warmed up, a piece of cloth is moistened and applied to the place where the organs protrude. Carry out the procedure 2 times a day for at least two weeks.
2. A solution of vinegar and water works well. They need to wash the swollen area. It is prepared like this: for 250 ml of water you will need 2 tbsp. l. table vinegar. After washing with this solution, make a warm compress of oak infusion for half an hour. To prepare it, you need to chop the acorns and oak bark, put in a container and fill it with red wine, leave for 21 days. Apply to the area of ​​swelling.
3. Poultices based on a decoction of hernia herb. Need to take the leaves medicinal plant, steam and apply to the sore area. The procedure is carried out 2-3 times a day. This method helps to avoid complications.
4. In the treatment of inguinal hernia, it is recommended to drink various infusions from medicinal herbs. They will help strengthen tissues and ligaments. For these purposes, it is often recommended to drink an infusion of cornflower flowers. To prepare the decoction you need to take 3 tbsp. l. raw materials, pour 1 tbsp. boiling water, leave to brew and drink 1 tbsp. l. 3 times a day. They also drink a decoction of gooseberry leaves or drupes prepared in the same way.
5. A hernia can be treated with a hot infusion prepared using larch bark. To prepare you will need 125 g of bark, pour 2 tbsp. boiling water, leave for 12 hours. Strain and drink once a day for two weeks. This solution is also suitable as a compress.

Traditional medicine in the treatment of hernia is only an additional remedy, but not the main one. They will help the patient simply wait for the operation and prevent serious complications, but they will not be able to completely cure the disease.

Treatment without surgery

If a child is admitted to the hospital, and after examination the surgeon does not identify any absolute indications for surgical intervention, then in the hospital he is given a set of measures to correct the hernia. The patient is administered a single dose of Pantopon, which is calculated depending on the age of the child. After this, a warm bath is taken.

The water temperature is no more than 38 °C, the procedure lasts about a quarter of an hour. You can simply place a warm heating pad on the groin area. After all these procedures, the baby calms down and falls asleep, and only after that the hernia is spontaneously reduced. A similar result can be achieved in a third of patients admitted to the hospital.

Conservative therapy lasts no more than an hour. If the protrusion does not disappear within this period of time, a date for surgical intervention is set, then all manipulations are considered preoperative preparation. If there is no way to do without surgery, then no preoperative measures are taken.

There are several basic methods that can strengthen the abdominal muscles. They will not give a 100% result, so you need to regularly monitor your child.

Basic methods:

Complications

According to statistics, after surgical removal of a hernia, relapse can occur in only 1% of patients. Most often, premature babies and those with poorly developed connective tissue are at risk.

The disease may return if the operation was performed urgently. If the diagnosis is made as early as possible and surgical intervention is performed as planned, without waiting for any complications, then serious consequences there won't be.

If the operation was performed by an unqualified surgeon, then the following complications may appear in the future:

• infertility;
• high testicular fixation;
• lymphostasis;
• lymphocele.

If you do not act, the following may happen:

• infringement− internal organs are compressed and then die;
• peritonitis− begins inflammatory process due to the fact that an organ rupture occurs;
• coptostasis- retention of feces in a loop that has entered the hernial sac;
• ischemic orchitis− the testicle becomes inflamed due to the fact that blood circulation is impaired.

To prevent complications, it is necessary to urgently carry out a surgical process that will not harm the baby. An inguinal hernia will not cause any inconvenience to the child if the diagnosis is made in time and surgery is performed.

If children have contraindications for urgent surgery, then methods can be temporarily used conservative treatment, but they will not cure, but only alleviate the condition of boys and girls. Massage, wearing a bandage and reduction will be a good solution, but not for long.

Therefore, at the first opportunity, it is worth carrying out surgical intervention and forgetting about the disease once and for all. A hernia is not a death sentence; any surgeon can solve the problem in just 1 hour, and within a few days the child will be able to lead a full life, without limiting himself in any way. But inaction in some cases can even cost a child’s life.

Video about inguinal hernia in children, its symptoms and treatment methods

Treatment of inguinal hernia in children:

Causes and symptoms of inguinal hernia in children:

Reading time: 6 minutes. Views 2.2k. Published 04/29/2018

Good afternoon, dear readers.

In addition to the usual runny nose, allergies and other minor troubles, babies often experience more serious illnesses, which require long-term treatment, sometimes surgery. Why does an inguinal hernia occur in children, how to recognize the problem in a timely manner? How to treat, and whether surgical intervention is always necessary - we will talk about all this today.

Inguinal hernia - what is it?

An inguinal hernia is the most common type of external hernia. Due to more developed abdominal and groin muscles, pathology is less common in girls than in boys. The disease can be congenital or acquired.

In the abdominal cavity there is a small gap called the inguinal canal, inside is the spermatic cord in boys or the round ligament of the uterus in girls. If, due to certain circumstances, the peritoneal organs protrude through this gap, a hernia is formed.

Types of hernia formations

1. Oblique - pass through the inguinal canal and spermatic cord. The hernia can be cordial, canal, and with the inguinal-scrotal type of tumor, the hernial sac is located in the scrotum.
2. Direct hernias do not affect the spermatic cord.
3. Reducible - often disappear on their own.
4. Irreversible - the hernial sac fuses with the contents, such a neoplasm cannot be reduced.
5. More often in boys at an early age a hernia is diagnosed on the right side, less often a protrusion occurs on the left, bilateral pathology occurs only in 10% of young patients.

A small tumor in the groin area consists of a hernial orifice, a sac with various contents; the tumor is more noticeable in a standing position. With timely diagnosis, the pathology can be successfully and quickly treated.

Causes of congenital inguinal hernia

In boys, the testicles form in the abdomen, gradually descend into the scrotum, and in the process of movement, the vaginal process is formed - a pocket from the peritoneum. If this process does not close in time, an inguinal hernia will form in boys. They get into the hernial sac bladder, omentum, intestinal loops, appendix.

Hernia is often inherited, so if you or your husband or immediate family have had a similar problem, be sure to tell your pediatrician about it.

A congenital inguinal hernia in girls is formed due to abnormal development round ligaments of the uterus. During intrauterine development, the uterus is high, gradually descends into the small pelvis, pulling the peritoneum with it, forming the same pocket as in boys.

The hernia often appears in combination with cystosis of the spermatic cord, dysplasia hip joint, spinal abnormalities, testicular dropsy.

Why does a hernia develop after birth?

Acquired inguinal hernias are a rare occurrence; in infants, the pathology most often occurs against the background of frequent strong tension in the abdominal muscles.

• severe cough;
• constant crying;
• constipation;
• prolonged vomiting;
• underdevelopment of the abdominal wall muscles;
• the tumor occurs more often in underweight children.

IN adolescence a hernia may occur due to weak muscles abdominal wall, groin injuries, high intra-abdominal pressure, sudden weight loss or weight gain. The main provoking factors are heavy lifting, excessive physical activity or a sedentary lifestyle.

If your child is active and plays sports, then his risk of developing a hernia is minimal.

How to recognize an inguinal hernia

Abnormal protrusion has pronounced characteristic symptoms, which allows you to notice it in a timely manner.

Signs of a hernia:

1. A swelling appears in the groin area, which increases during screaming, crying, straining, or when the child moves to an upright position.
2. In boys, the tumor is oval, in girls it is round.
3. Deformation of the scrotum or thickening of one of the labia.
4. Reduction of a simple hernia occurs by light pressure, discomfort the baby does not experience any pain during the procedure.
5. If the hernia has a complex structure, then pain and frequent constipation appear; if there are loops of intestine in the hernial sac, you will often hear a soft rumbling.

A load on its own can be confused with a hydrocele - both protrusions are similar in appearance, but with a hydrocele, there is fluid inside the neoplasm, not tissue.

The main danger of pathology is the infringement of organs that are trapped in the hernial sac, therefore, when the first signs of pathology appear, you must contact a surgeon or urologist.

Diagnostic methods

The doctor will be able to make an initial diagnosis after examination and medical history; to clarify the severity of the disease, an ultrasound of the abdominal organs is prescribed; girls are additionally examined for the pelvic organs. Sometimes an X-ray with a contrast agent is additionally prescribed.

If the doctor decides that surgery is necessary, it is necessary to do a general blood and urine test, a coagulation test and a blood group test.

Treatment without surgery

If a child has been diagnosed with an inguinal hernia, and there are no indications for surgery, treatment is carried out using conservative methods.

The child is prescribed Pantopon, after taking the medicine the baby should be placed in a bath for a quarter of an hour, the water temperature is 37–39 degrees, go apply a warm heating pad to the groin area. After the procedures, which last no more than an hour, the baby falls asleep and the hernia repairs itself. The effectiveness of the method is 30–35%.

If such manipulations do not reduce the formation, it is necessary to undergo surgery.

Will a bandage help?

A special device supports the anterior abdominal muscles, prevents displacement of internal organs, which reduces the risk of increasing protrusion.

It is recommended to wear the bandage only during the day; it can be left at night only if the child has a severe cough, or he screams and cries a lot in his sleep. Additionally, physical therapy and massage are prescribed to strengthen the peritoneum.

But all these measures are temporary; even if the treatment is successful, the probability of relapse in children under 4 years of age is more than 70%.

Hernia surgery

Surgical removal of congenital protrusion is performed on children aged 6–12 months; surgeons are increasingly resorting to laparoscopy - several small holes are made in the abdomen, and the progress of the entire operation is displayed on monitors. The doctor separates the pouch and peritoneum and moves the organs to the correct position.

You should not be afraid of the operation; it is performed under general anesthesia; the duration of the manipulations is no more than half an hour. If there are no complications, then the very next day you and your baby will be home.

What to do after surgery:

• accept antibacterial drugs With wide range actions;
• wear special supportive underwear;
• the diet should be dominated by foods high in protein and fiber;
• physical activity is contraindicated, but after a month you need to start doing physical therapy, the complex will be selected by a physiotherapist.

Are there relapses?

Repeated protrusion is diagnosed in 1% of patients; repeated complex, traumatic surgery is required. Most often, such a complication occurs against the background of connective tissue abnormalities in premature babies.

Why is a hernia dangerous?

A strangulated hernia requires immediate hospitalization; intestinal strangulation develops intestinal obstruction, tissue necrosis. Signs of infringement - sharp pain in the groin area, severe diarrhea and vomiting, which is followed by constipation, fever, the skin in the affected area becomes red and hot to the touch. All symptoms develop rapidly.

For girls, even short-term infringement can cause the death of eggs and necrosis of the gonads; in boys, ovarian atrophy develops due to impaired blood circulation. Therefore, a pinched hernia in childhood can cause infertility.

Conclusion