Care After Inguinal Hernia Surgery

A hernia is when body tissue pushes through an opening or weak spot in a muscle wall inside the body. It pushes into a space where it doesn't belong.

In children, an inguinal (IN-gwuh-nul) hernia is connected by a sac of tissue in the groin that normally closes at birth. If the sac does not completely close off, a connection remains between the groin and the lower belly. Fluid, intestine, fat, or even an ovary (the organ that holds eggs) can fill this sac and cause it to swell. They are not due to muscle weakness. Inguinal hernias can be pushed back into the belly (abdomen).

An inguinal hernia occurs near the crease between the abdomen and leg.

If your child has an inguinal hernia, you may see swelling or a bulge in the groin area while you bathe or change your child’s diaper. The swelling can extend down into the scrotum or the labia. This bulging can increase when your child is active or crying and it may decrease as your child lays down and relaxes. It is possible to have a hernia on both sides.

Most children with an inguinal hernia do not have pain but some can be fussy or complain of pain with exercise.

The surgeon will talk with you or your child and then carefully examine your child's belly area and groin on both sides to feel if a hernia is present.

We do not usually order imaging studies (like x-rays or ultrasounds) to look for hernias, because they can be hard to detect.

• An inguinal hernia will not go away if left alone.
• Activities such as running, crying, or straining for a bowel movement can make the hernia appear larger and can be uncomfortable.
• The opening needs to be closed to prevent an incarcerated hernia.

An incarcerated hernia is when an inguinal hernia has a portion of intestine, or an ovary, twisted or trapped in the opening and won’t go back into the belly (abdomen). This is very rare but can happen at any time.

This is an emergency that needs to be fixed right away, because the blood supply to that organ can be cut off and lead to serious damage.

Call 911 for an ambulance or take your child to the emergency room if you notice signs of an incarcerated hernia:

• Sudden, sharp pain that doesn't go away, a bulge sticking out in the groin area that will not go back into the belly, and your child will not stop crying (inconsolable).
• Your child has nausea and vomiting green fluid (bile).
• The bulge feels very hard and doesn't go back into the belly (it does not retract).
• The skin around the hernia is discolored, darker, purple or red.

Your child will be in the operating room and given medicine (general anesthesia) that will cause your child to be asleep and not feel pain during surgery. In addition to general anesthesia, we may also offer regional anesthesia. Regional anesthesia numbs a certain area of the body. We inject numbing medicine near the spine (epidural), or around certain nerves (peripheral nerve block) so your child will feel less pain in that area.

We cut (make an incision) along the inguinal space near the crease between the abdomen and leg. We drain any collected fluid and place all organs in the correct spot if any shifted through the opening.

The hernia connection is then closed with small stitches that will dissolve over time. You will not be able to notice these inner stitches from the outside. The incision is often covered with skin glue (Dermabond). You won’t see any stitches on the outside skin. The stitches are underneath the skin and will dissolve on their own.

Laparoscopic Surgery
Sometimes we recommend fixing the hernia using a small camera and instruments inside the belly (abdomen). This is called laparoscopic surgery. Small cuts (incisions), usually less than an inch long, are made on the abdomen. The doctor will place a thin camera and instruments through the incisions to do the surgery. Your surgeon will tell you more details if you have this kind of surgery.

Most children go home the same day of surgery.

If your child has another medical condition, they may need to stay overnight.

It is common for children to feel sick (have nausea) and throw up (vomit) after surgery. Slowly give your child sips of water to help.

If your child is feeling better, not throwing up, and fully awake, it is okay to start their regular diet.

• The incision will be closed with dissolvable stitches. You won’t see any stitches on the outside skin.
• Dermabond (tissue glue) is used to cover the incision. This will usually peel or flake off on its own within 10 to 14 days.
• There will be some swelling of the groin area and mild bruising around the incision, scrotum, or labia. This can take several weeks to go away.

If skin glue (Dermabond) was used to close the skin incision:

• It is ok to shower 24 hours after surgery.
• No soaking, tub bathing, or swimming for 1 week, although a shallow bath is okay for infants and toddlers.

If there is gauze or Tegaderm dressing over the incision:

• Remove it after 48 hours. You can do this before or during a shower.
• No soaking, tub bathing, or swimming for 1 week.

Some school-aged children may need to stay home to rest 1 day after surgery. If they feel well enough, they can return to school after that.

If your child is 10 years old or younger:

• There are no restrictions. Your child can be as active as they can tolerate.

If your child is 11 years old or older:

• No lifting more than 15 lbs. (6.8 kg).
• No sit-ups or excess use of abdominal muscles for 3 weeks.
• No competitive sports or PE (physical education or gym) class for 1 week.
• It is ok for your child to run or ride a bike as comfort allows.

After surgery, your child will likely feel pain in the groin.

We partner with you and your child to relieve pain as much as possible. You know your child best. We encourage you to take an active part in your child's recovery. Your child should feel better the next day.

• After-surgery pain can typically be treated with over-the-counter pain medicines acetaminophen (Tylenol) and ibuprofen (Motrin or Advil).
• When giving these 2 medicines, you should alternate between the 2 medicines every 3 hours. This means your child receives acetaminophen every 6 hours and ibuprofen every 6 hours.
• It is important to stay ahead of the pain instead of waiting for the pain to get worse. For more information on this see our handout, “Pain Medicine after Surgery: Alternating acetaminophen and ibuprofen.”
  seattlechildrens.org/pdf/PE3756.pdf
• If your child's healthcare provider prescribed an opioid medication for pain, use this only if the acetaminophen or ibuprofen does not help relieve pain.
• Acetaminophen and prescription pain medicine may not be safe to use at the same time. Check with your healthcare provider or pharmacy.
• In addition to medicine for pain, you can also help your child cope by distracting them with music, games, books, TV, or videos.

• To keep your family safe, store medicines inside a locked cabinet or location where others cannot easily get to them. Once your child has recovered from surgery, dispose of all unused prescription medicines.
• Taking leftover pain or other medicines, on purpose or by accident, can be very dangerous.
• For more information about safe disposal of unused opioid medicine, read our handout “Safe Use and Disposal of Opioid Medicines.”
  seattlechildrens.org/pdf/PE3140.pdf

We will call you 5 to 7 business days after surgery to check on you. There is no follow-up clinic visit needed, but you are welcome to schedule a follow-up visit if you would like to be seen or if you have any concerns.

Send MyChart messages for non-urgent questions.

Monday to Friday, for questions or urgent concerns listed below, call General Surgery at 206-987-2794.

Nights, weekends, and holidays, if you have urgent concerns from the following list call 206-987-2000 and ask for the General Surgeon on call.

• Fever higher than 101.5° F (38.6° C) for more than 24 hours
• Redness, swelling or discharge (fluid) from the wound
• Rapid swelling or bleeding from the surgery site
• Severe, constant pain at the surgery site not controlled by the medicine prescribed
• Throwing up (vomiting) 4 or more times in 12 hours
• Cannot pee for a span of 8 hours after surgery
• Persistent scrotal swelling that lasts more than a couple of months