Baby a cry, belly bulge?Parents should not be careless
On the way to the child’s growth, parents will encounter all kinds of problems, such as: found that the child’s stomach suddenly bulged up a small lump, when large, when small, sometimes no;They often appear when standing, coughing or crying, and disappear when quiet…Some elders with “experience” think: “This is because the child temper, love crying and children’s hernia, grow up.”Is that so?Inguinal hernia (also known as “infantile hernia”)/hydrotheca is a common disease in pediatric surgery, the problem can be big or small, parents and friends can not be ignored.Jiahui jun invited Dr. Qingxing Li, pediatric surgery department of Jiahui Medical, to bring you a detailed understanding of inguinal oblique hernia and hydrocele through 5 questions.Oblique inguinal hernia/hydrocele is crying disease?Inguinal hernia/hydrocele is most common in children less than 1 year old, and the incidence is 3-4 times higher in boys than in girls.Primary inguinal hernia occurs in 1% to 5% of all newborns and 9% to 11% of preterm infants. The pathogenesis is related to the failure of sheathoid process closure during embryonic development.The main difference between the two is that the contents of the sheath cavity are different: the contents of the sheath cavity of the inguinal indirect hernia are the intestine, ovary or even uterus;The contents of the sheath cavity of hydrocele are liquid.Sometimes both bowel and fluid may be present in the lumen.What are the risks of indirect inguinal hernia/hydrocele?(1) Relative to inguinal indirect hernia, it is more harmful. If the contents of the sheath cavity (intestine and ovary) cannot be brought back to the abdominal cavity in time, incarceration is likely to occur, which affects the blood supply of relevant organs and may even lead to ischemic necrosis.(2) The harm of communicative hydrocele is relatively secret. The contents of communicative hydrocele can be withdrawn into the abdominal cavity after the child is quiet and lying flat, but the communication port is relatively small. Under some inducing factors, the intestine and ovary may enter the sheath cavity but cannot be withdrawn into the abdominal cavity, causing the situation of visceral impaction.Therefore, parents and friends can not be careless.Even if the above situation does not occur, it should also be noted that children with indirect inguinal hernia are prone to chronic abdominal pain, constipation and other symptoms if they have not been treated for a long time.Hydrocele may also increase over time.Surgical versus conservative treatment, which one?At present, the mainstream treatment for inguinal hernia/hydrocele is surgical treatment rather than conservative treatment such as hernia band compression.For the timing of surgery: most opinions suggest that the time of inguinal hernia surgery is 6 months of age.Some studies suggest that the waiting time for surgery after finding an oblique inguinal hernia should be less than 14 days. Hydrocele can be observed at the age of 1-2 years, and the need for surgery depends on the degree of hydrocele absorption, and the presence of indirect inguinal hernia should be noted during this period.Which kind of operation means is better?For oblique inguinal hernia/hydrocele in children, the mainstream treatment is surgical high ligation of the sheath process, including inguinal cutaneous incision and umbilical incision under laparoscopy.How to choose between different types of surgery?There is no better way, only the right way.(1) the first line of elective surgical procedures for children s suggestion inguinal region dermatoglyph incision surgery, for the following reasons: (1) incision advantage: single (only need a surgery was performed on the wound), small (1 cm long), does not destroy the peritoneum integrity (to avoid the late navel and intestinal canal forms adhesion rope belt may) can be high ligation sheath DCS.(2) Anesthesia advantage: to avoid uncomfortable throat caused by endotracheal intubation and pneumoperitoneum syndrome.■ However, there are still some issues to be discussed: at present, there is controversy about whether contralateral inguinal exploration is necessary .In the children with patent sheaths during the natural process of embryonic development, about 40% of them closed naturally within 2 months after birth, and the other 20% closed within 2 years after birth.The remaining 40% patent sheath processes are in the middle, half of which may develop inguinal hernia .Therefore, finding asymptomatic patent sheaths is not a clear indicator of future inguinal hernia.(2) Laparoscopic surgery is recommended for incarcerated oblique inguinal hernia, recurrent hernia, and cases where oblique hernia was previously found on one side but recently found only on the opposite side.In conclusion, if repeated inguinal masses are found in children, timely medical treatment and clear diagnosis should be made. Almost all children with inguinal hernia need treatment.If the groin mass does not resolve on its own, incarcerated hernia may occur and immediate medical attention should be sought. Grosfeld JL. Current Concepts in Infants and Children. World J Surg 1989;13:506. Zamakhshary M, To T, Guan J, Langer JC. Riskof incarceration of inguinal hernia among infants and young children awaitingelective surgery. CMAJ 2008;179:1001. Wang KS, Committee on Fetus and Newborn,American Academy of Pediatrics, Section on Surgery, American Academy ofPediatrics. Assessment and management of inguinal hernia in infants. Pediatrics2012; 130:768. Rowe MI, Clatworthy HW Jr. The other side ofthe pediatric inguinal hernia. Surg Clin North Am 1971; Then 71.