Hernias: Inguinal, Femoral, Umbilical, Epigastric, and Hydrocele

Inguinal hernia is one of the most common surgical conditions in infancy, with a peak incidence during the first 3 months of life. The diagnosis of inguinal hernia is made with increasing frequency in newborns, and this period carries a particularly high risk of incarceration. The incidence of hernia also is much higher in premature infants, who now survive in growing numbers with sophisticated intensive care management. Direct hernia is exceedingly rare at this age; nearly all congenital indirect inguinal hernias develop because the processus vaginalis remains patent after birth. The most common presentation of inguinal hernia in a child is a groin bulge, extending towards the top of the scrotum. The treatment of inguinal hernia is always surgical. In infants and toddlers, herniotomy can be performed through the external inguinal orifice without any attempt at parietal reinforcement. In older children, however, the length of the canal makes it advisable to open the external oblique aponeurosis in order to achieve a high ligation of the sac. Although more than 80% of major surgical pediatric centers still prefer open technique, there are many surgeons who repair the hernia by laparoscopy, with either single or multiple ports or with transcutaneous or intracorporeal sutures. Recent evidence-based literature suggest that these advantages should be carefully weighed. Undoubtedly, it seems clear that this approach may be useful for recurrent hernias in which inguinal canal scarring makes open dissection difficult.