Surgery - management of Inguinal hernia in the neonate
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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.
Pre-operative care of infants with Inguinal Hernia
- Follow standard steps for preoperative care.
- If difficult to reduce, call the on-call surgeon or surgical registrar.
- If still irreducible, will require surgery.
- If reduces keep overnight and operate next day as acute.
- 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.
- Discuss with parents of child:
- Incidence of bilaterality (10%)
- Risk of injury to vas/testicular vessels
- Recurrence (3%)
- Testicular atrophy (especially incarcerated hernias)
Post-operative care of the infant with an Inguinal Hernia Repair (Herniotomy)
- Follow standard steps for postoperative care.
- Observe wound for signs of bleeding, excess bleeding is reported to doctor/NS-ANP.
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- 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
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