Hernia surgery in children

Paediatric inguinal hernias are characterised by a swelling in the groin region. In boys, this can also extend down to the testicular sac (scrotum). This may be present constantly or intermittently, and is usually noticed by parents. In newborns especially, an inguinal hernia can cause discomfort, causing agitation and a tendency to cry. To differentiate between an inguinal hernia and a hydrocele, a diaphanoscopy is carried out. A small torch is used to illuminate the scrotum. This allows the contents of the hernia to be determined. Unlike most inguinal hernias, hydroceles can rarely be drained with compression. It is only if they incarcerate that repositioning is made more difficult or impossible, like with inguinal hernias. This is not too uncommon, since small children are not always able to explain their symptoms clearly. Incarcerations requiring emergency intervention therefore account for up to 12% of all paediatric inguinal hernias, especially at the newborn stage.

Paediatric inguinal hernias are always congenital, indirect hernias involving the internal inguinal ring. There is no weakness of the posterior wall of the inguinal canal, fascia or muscles. Unlike the surgical techniques used in adult hernia patients, a high hernial sac removal is sufficient.
We carry out this procedure under open surgery via small incisions in the skin made in the lower abdominal fold. With the Rehbein-Grob technique, the internal muscles are also adapted to the inguinal ligament following high hernial sac removal.
In girls, following high hernial sac removal, the round ligament is shortened and reattached to the muscles (Bastianelli technique).
The procedure is typically carried out under general anaesthetic. Depending on the patient and their physical findings, as well as the nature of the outpatient preparation, this may be carried out as a daycase procedure, i.e. the child is monitored for a few hours after the operation and can then be discharged home. There is however the option of inpatient monitoring in Starnberg Hospital's Paediatric Department.