Children's Hospital Colorado

Hernia Repair

What is a hernia repair?

A hernia occurs when abdominal contents, such as the intestines, protrude through a weakness in the muscles of the abdominal wall. Upon examination, there may be a visible bulge under the skin where the hernia is located.

There are two main ways to repair a hernia. If the hernia is “reducible,” it means that the contents of the hernia can be easily pressed back into the abdominal cavity. If the contents of a hernia cannot be pressed back in, the hernia is called “incarcerated,” or “irreducible.” When a hernia becomes incarcerated, patients show signs of irritability, including loss of appetite, changes in bowel patterns or tenderness in the area. If a hernia is incarcerated for a prolonged time, the portion of the intestine that is caught in the hernia could die. To prevent further injury to the intestine, your child’s doctor may recommend immediate surgery to reduce and repair the hernia.

There are three types of hernias common among children that we treat at Children’s Hospital Colorado: inguinal hernias, umbilical hernias and epigastric hernias.

What is an inguinal hernia?

An inguinal hernia occurs in the groin area. During normal male development, the testicles move down the groin and into the scrotum, bringing with them a part of the lining of the abdominal cavity. This tube-like connection between the abdomen and the scrotum normally closes around the time of birth. If the connection does not close, fluid or intestines are free to move back and forth from the abdomen into one or the other side of the scrotum. Although girls do not have testicles, they do have an inguinal canal, so they too can develop inguinal hernias.

Who gets inguinal hernias?

Approximately 1% to 3% of children are diagnosed with an inguinal hernia or a communicating hydrocele. A communicating hydrocele is a small open channel that allows fluid to move between the abdominal cavity and remain around a testicle or in one of the labia. Premature and low-birth-weight infants are at greater risk of developing an inguinal hernia or a hydrocele, in comparison to full-term infants.

How are inguinal hernias treated?

Inguinal hernias require an operation to be fixed. This type of surgery is generally done as soon as possible to avoid the risk of the hernia becoming incarcerated. In premature infants, surgery may be postponed for a few months until their lungs are more developed. To repair an inguinal hernia, your child will be given general anesthesia so they cannot feel any pain or discomfort during the operation. The surgeon then makes a small incision near the groin, moves any intestines that popped out back into the abdominal cavity, then repairs the abdominal wall. The procedure is fairly straightforward, and most children can go home the same day.

What is an umbilical hernia?

An umbilical hernia occurs at the belly button, or umbilicus. In most cases, umbilical hernias do not cause pain and can be gently pushed back into the abdomen. It is rare for umbilical hernias to become stuck (incarcerated), but if this occurs, your child should be seen by a physician as soon as possible.

In the developing baby, there is an opening in the abdominal wall (the umbilicus) that usually closes by the time the baby is born. If this opening has not closed by the time a baby is born, it becomes an umbilical hernia. This hernia allows either tissue or fluid to enter the protruding sac, which causes the skin at the umbilicus to bulge outward.

Who gets an umbilical hernia?

Umbilical hernias occur in approximately 20% of all newborns, but are more common in African Americans and premature infants.

What are the signs and symptoms of an umbilical hernia?

Umbilical hernias look like a bulge at the belly button that normally is soft and may appear and disappear. Most commonly, the hernia is noticed when the child strains, coughs or cries. Umbilical hernias can vary in size from very small to very large.

How do we diagnose an umbilical hernia?

Umbilical hernias are typically diagnosed by physical exam. Most umbilical hernias close by themselves by 5 years of age. If the hernia defect does not close by age 5, or if the child experiences an episode of incarceration, then earlier surgical repair may be recommended.

How are umbilical hernias treated?

If an umbilical hernia does not close by the time a child is 5 years old, we may suggest surgery to close it. If your child needs surgery, we will first give them general anesthesia. Then, the surgeon will make a small incision on the lower rim of the belly button and close the hole in the muscle layer. Most children go home the same day of surgery.

What is an epigastric hernia?

An epigastric hernia is a bulging of tissue or fat that occurs in the midline of the abdominal wall, between the chest and belly button. This type of hernia occurs when the fibrous tissue of the abdomen does not close all the way during development, therefore leaving a defect.

Who gets epigastric hernias?

Epigastric hernias occur most commonly in boys.

What are the signs and symptoms of an epigastric hernia?

When children with an epigastric hernia cry, have a bowel movement, or bear down, a small lump will bulge out somewhere along the center or midline of their body, between the breastbone and the belly button. When the lump pushes out, children may express fussiness or pain and not want to eat. A surgeon will typically diagnose an epigastric hernia by reviewing your child’s medical history and performing a physical exam.

How are epigastric hernias treated?

Epigastric hernias are treated with surgery. Without surgery, the hernia will likely get bigger and become more painful. Rarely, the hernia can get stuck or “incarcerated,” causing decreased blood flow to the tissue that is trapped inside the defect. Your child may have sudden pain and you may see or feel a hard lump between the breastbone and the belly button.

Why choose us for hernia treatment?

Our Pediatric Surgeons have performed surgery on thousands of hernias of all different types, shapes and sizes. No matter how common the procedure may be, each case can be different. This makes their experience all the more important. All our surgeons are specially trained and experienced in the surgical care of children.

We also have pediatric anesthesiologists to help ensure our patients remain safely asleep throughout the surgery. We encourage patients and their parents to meet with our anesthesiologists before the surgery to ask questions and ease concerns about the process. They are experts at answering questions from kids to help them feel safe and comfortable about the procedure.