Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Chapter 176. Pediatric Inguinal Hernia Repair

Philipp J. Houck, MD

  • Inguinal hernia: protrusion of intestinal organs through an open processus vaginalis
  • Incarcerated hernia: content does not slide back into the abdominal cavity
  • Strangulated hernia: vascular supply becomes insufficient

  • Depending on associated morbidity and surgical requirements, neuraxial anesthesia, GETA, LMA, or a mask airway is appropriate
  • A wide variety of regional anesthesia techniques can be used for inguinal hernia repair, either as an anesthetic or for analgesia
    • Caudal blocks can be used, more often as an adjunct to general anesthesia
    • In older patients, ilioinguinal and iliohypogastric nerve blocks can be performed either preoperatively percutaneously or during the procedure by the surgeon
  • Spinal anesthesia for infants:
    • Not demonstrated to reduce risk of postoperative apnea
    • Experienced helper who positions and holds patient, keeps head in neutral position to avoid airway obstruction
    • Skin infiltration with 1% lidocaine
    • 22G 1.5-in styletted needle L4/5 or L5/S1
    • One-milliliter syringe with 0.8 mg/kg 1% tetracaine in D5W, may add epinephrine wash
    • Slow injection of anesthetic to avoid total spinal, maintain patient horizontal after injection to avoid cephalad spread
    • Airway obstruction or apnea indicates a total spinal, which requires immediate endotracheal intubation

  • Postoperative apnea in 20–30% of otherwise healthy former preterm infants undergoing inguinal hernia repair
  • Risk of postoperative apnea decreases with the postconceptional age of the infant
  • Spinal anesthesia often chosen for these patients, although not shown to reduce incidence of apnea and bradycardia
  • Admit for observation overnight to monitor for apnea:
    • Ex-preemies (patients born at 36 weeks or earlier) <60 weeks postconception
    • Patients born full term (37 weeks or later) <45 weeks postconception

  • Laryngospasm may occur during surgical manipulation of the hernia sac, if anesthesia is too light
  • Most common surgical procedure in children
  • Higher incidence in premature babies
  • Often bilateral, debate about need to explore contralateral side
  • In ex-preemies, surgery usually performed prior to discharge from NICU
  • Laparoscopic inguinal hernia repair usually requires endotracheal intubation. However, a brief insertion of a laparoscopic camera in the contralateral hernia sac after an open repair of the other side does not require a change in the anesthetic technique

+
+
1. Welborn LG, Rice LJ, Hannallah RS, et al. Postoperative apnea in former preterm infants: prospective comparison of spinal and general anesthesia. Anesthesiology. 1990 May;72:838–842.   [PubMed: 2187377]
+
+
2. Craven PD, Badawi N, Henderson-Smart DJ, O’Brien M. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev. 2003;3(3):CD003669.   [PubMed: 12917979]
+
+
3. Sims C, Johnson CM. Postoperative apnoea in infants. Anaesth Intensive Care. 1994 Feb;22:40–45.   [PubMed: 8160948]
+
+
4. Lau ST, Lee YH, Caty MG. Current management of hernias and hydroceles. Semin Pediatr Surg. 2007 Feb;16:50–57.   [PubMed: 17210483]
+
+
5. Kumar VH, Clive J, Rosenkrantz TS, Bourque MD, Hussain N. Inguinal hernia in preterm infants (< or = 32-week gestation). Pediatr Surg Int. 2002 Mar;18:147–152.   [PubMed: 11956782]

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close