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364 Inguinal and Femoral Hernias and Hydroceles Inguinal and Femoral Hernias and Hydroceles
365 Inguinal and Femoral Hernias and Hydroceles 365

Key Summary Points
1. Hernias and hydroceles in children are considered congenital 5. If manual reduction is successful, plan to operate on the child
and are diagnosed clinically (history and examination). Indirect on the next available elective list, preferably within the next 72
inguinal hernias are overwhelmingly more common than other hours because the oedema would have subsided by then.
groin hernias.
6. If manual reduction fails, the child must be operated on
2. Open herniotomy is the operation of choice for inguinal hernias immediately after the necessary preoperative preparations.
in children in our subregion. These hernias can also be 7. An encysted hydrocele of the spermatic cord may mimic an
repaired laparoscopically. incarcerated hernia; therefore, careful examination of the child
3. Femoral hernias are very rare in children but should be kept is important.
in mind as a differential diagnosis for groin hernias. If there 8. In the case of a dull transillumination of a groin mass, an
is recurrence after surgery for an indirect inguinal hernia in attempt should be made to exclude an inguinal hernia, which in
a child, it is important to exclude a direct inguinal hernia or a infants may transilluminate dimly.
femoral hernia.
4. An attempt should be made to manually reduce all
incarcerated hernias in children, especially in infants, under
sedation and analgesia.

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