Hernias and Hydroceles
When the testicle travels from the abdominal cavity to the scrotum before birth, it travels along an open channel that usually closes by the time a child is born. Girls also have this open channel. If the channel does not close, a hernia or hydrocele may develop. A hernia occurs if the channel is wide and a piece of intestine can slide down into it. If the channel is more narrow, only fluid from the abdominal cavity can get down it. This fluid may surround the testicle in the scrotum, forming a hydrocele.
How important is a hernia?
A hernia is a serious problem at any age because the intestine can get stuck in it and become trapped or lose its blood supply. Therefore, we usually recommend fixing a hernia soon after we observe it.
How important is a hydrocele?
Hydroceles are very common in newborn boys and may be very large. They may change in size as fluid goes into and out of them. They do not cause any injury to the testicle. Since the channel is usually narrower than with a hernia, it may close off by itself in the first 3 to 6 months of life. After it closes, the fluid will gradually disappear.
What are the symptoms?
A hernia causes a bulge in the groin area, often when your child cries, coughs or strains. The bulge may disappear by itself of with gentle pressure. If not, it is important to bring your child to the doctor immediately. If intestine is stuck in a hernia channel, your child may become feverish, fussy or start vomiting. If a hydrocele alone is present, the scrotum on that side is enlarged and may appear bluish in color. There is no bulge in the groin, however.
Who is more likely to have a hernia?
Hernias are more common in boys with undescended testicles and in children who were born prematurely. If your child has a surgical shunt tube going from the brain to the abdomen, the risk may also be higher.
What is the treatment?
For hernias, treatment is recommended as soon as feasible. Surgery is done under general anesthesia and an incision is made in the groin area, usually in a natural skin fold. The channel is separated away from the other tissues and tied off. If the hernia is on one side, there is a risk of one developing later on the other side. This risk is about 10-20% if your child is less than 1 year old and 5% if he is older. Your doctor will discuss whether or not operating on the other side is indicated.
For hydroceles, we usually recommend waiting until your child is close to one year of age to see if the hydrocele will go away on its own. If it is still present, we will do the same type of surgery as described above. Sometimes surgery will be performed earlier if the hydrocele is very large or continues to shrink and expand after 6 months of age or if a hernia is also present.
What does surgery involve?
This type of surgery is usually performed without an overnight stay in the hospital, unless your child is less than 4 months old. The procedure usually takes 1 hour or less. The stitches are placed under the skin and dissolve, and the dressing falls off on its own 1 to 2 weeks after surgery. Your child may need either plain Tylenol or Tylenol with codeine every 4 to 6 hours as needed for pain after surgery. He should avoid strenuous activity for 2 weeks after surgery and should wait for 24 hours to bathe. He may be able to return to school as early as 2 to 3 days after the surgery. Complications of surgery are very rare, but are more likely if your child has previous groin surgery. Possible risks include infection, bleeding, recurrence, pulling up of the testicle into the scarred area and complications of anesthesia.
When to call the doctor
Call our office (812-282-38990 after surgery if your child runs a fever (over 101), has worsening pain, redness spreading around the incision, swelling or drainage, or for any other questions or concerns.