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Surgery - management of Inguinal hernia in the neonate

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Overview

Inguinal herniae are common in preterm infants. They result from failure of closure of the processus vaginalis - a covering or peritoneum that encloses the testicles during their descent into the scrotum. Bowel is able to enter the inguinal canal. They are most common in males (90%), and up to 15% of infants will have bilateral herniae (in preterm infants, it is common to repair both sides even if a hernia is present on one side). A palpable hernia in a female could represent an ovary.

It is important to differentiate between a hernia and a hydrocoele. In a hernia, bowel enters the inguinal canal. There is a mass at the inguinal ring which can usually be reduced. Hydrocoeles are collections of fluid within the processus vaginalis and scrotum - one can palpate above them, they transilluminate, and are irreducible.

Hernia reduction

Pre-operative care of infants with Inguinal Hernia

  1. Follow standard steps for preoperative care.
  2. If difficult to reduce, call the on-call surgeon or surgical registrar. 
  3. If still irreducible, will require surgery. 
  4. If reduces keep overnight and operate next day as acute. 
  5. If <44 weeks for full term or <60 weeks for preterm keep on ward for one day on apnoea monitor then home with GP visit in one week. 
  6. Discuss with parents of child:
    1. Incidence of bilaterality (10%) 
    2. Risk of injury to vas/testicular vessels 
    3. Recurrence (3%) 
    4. Testicular atrophy (especially incarcerated hernias)

Post-operative care of the infant with an Inguinal Hernia Repair (Herniotomy)

  1. Follow standard steps for postoperative care.
  2. Observe wound for signs of bleeding, excess bleeding is reported to doctor/NS-ANP.

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Document Control

  • Date last published: 01 April 2005
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years