Elsevier

Advances in Pediatrics

Volume 67, August 2020, Pages 131-143
Advances in Pediatrics

Inguinal and Other Hernias

https://doi.org/10.1016/j.yapd.2020.03.009Get rights and content

Section snippets

Key points

  • An indirect inguinal hernia is a common cause for evaluation, with a higher incidence in boys and premature/low birth weight infants.

  • Benefits of early repair include avoiding the risk of incarceration/strangulation versus the benefits of delayed repair include minimizing the cardiopulmonary risks of anesthesia and decreasing the risk of recurrence.

  • There is variability among pediatric surgeons with regards to exploring the contralateral side; the risk of developing a hernia with a patent

Embryology

The inguinal hernia in the neonate is the result of an arrest of normal embryologic development. Beginning around 12 weeks of gestation, a “finger” of peritoneum enters the inguinal canal and descends into the scrotum as the processus vaginalis in boys. This process is followed by descent of the testes between 28 and 36 weeks of gestation. The processus then closes and is obliterated by 36 to 40 weeks of gestation, although 40% of patent processus vaginalis may close within the first few months

Umbilical hernia

All neonates have a defect at the umbilicus through which the umbilical vessels traverse. This defect closes spontaneously in the majority during the early days to weeks of infancy. An umbilical hernia is present in 15% to 23% of newborns, and the incidence is higher in premature and low birth weight infants compared with term infants [42]. In a recent systematic review, a large majority of umbilical hernias (>90%) close spontaneously without surgical intervention within the first couple of

Epigastric hernia

Epigastric hernias or congenital ventral hernias are usually superior to the umbilicus and the result of failure of the linea alba to approximate in the midline during the final stages of abdominal wall development. They comprise 4% of all pediatric hernias and approximately one-half are symptomatic or enlarging [48]. Surgical repair is recommended in an elective fashion, usually performed via an open approach. An ultrasound-guided approach has also been described, performed similarly as for

Rare pediatric hernias

Direct inguinal hernias and femoral hernias are a rare occurrence in the pediatric population with a reported incidence of 0.2% to 2.0% and 0.2% to 1.0%, respectively [50,51]. These hernias are difficult to diagnose clinically, and recently more are being identified with the advent of laparoscopy and laparoscopic repair of inguinal hernias. Both direct and femoral hernias have been found in the setting of recurrence after open inguinal hernia repair (which may have been misdiagnoses initially).

Summary

Despite being a common diagnosis and procedure, there is still significant variability in practice patterns with regards to surgical management of pediatric hernias, especially in the former preterm infant with an inguinal hernia.

Disclosure

The authors have nothing to disclose.

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