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Indirect Hernia
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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When people have been doing orchidopexies and don't stitch the hole closed, patients usually do not get a hernia afterward, suggesting that scar alone may be enough and you may not need to ligate anything. — Todd, Inguinal Hernias: Diagnosis and Management · 9:59
Inguinal Hernias: Diagnosis and Management
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Inguinal hernia repair is the second most common surgery performed by pediatric surgeons. Here, we discuss the basics of diagnosis and management for inguinal hernias with Dr. Meera Kotagal. Special guests Rae Hanke and Gillian Goddard.Chec
podcast16:29 · Apr 2021
Pediatric Inguinal Hernia in Brief: Presentation, Workup, Diagnosis, Perioperative Considerations
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Inguinal hernia repair is the second most common surgery performed by pediatric surgeons so here, we cover the basics of presentation, diagnosis, surgical approach, and post operative management with Dr. Meera Kotagal and host Dr. Rod Gerar
video · Sep 2021
If a patient has an undescended testicle that's palpable in the inguinal canal, you should plan to do an orchiopexy at the time of your inguinal hernia repair. — Meera Kotagal, Pediatric inguinal hernia diagnosis, management, and complications · 14:01
Pediatric inguinal hernia diagnosis, management, and complications
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Inguinal hernia repair is the second most common surgery performed by pediatric surgeons. Here, we discuss the basics of diagnosis and management for inguinal h
podcast15:59 · Nov 2026
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Pediatric Inguinal Hernia in Brief: Presentation, Workup, Diagnosis, Perioperative Considerations
Inguinal hernia repair is the second most common surgery performed by pediatric surgeons.
epidemiologicalMeera Kotagal0:00 ↗
The incidence of inguinal hernias overall ranges from about 1% to 5% in full-term newborns.
epidemiologicalMeera Kotagal1:00 ↗
The incidence of inguinal hernias increases to about 13% in premature infants who are less than 32 weeks of gestational age.
epidemiologicalMeera Kotagal1:15 ↗
Most inguinal hernias in children are largely indirect, over 90%.
epidemiologicalMeera Kotagal1:30 ↗
Direct hernias are pretty rare in children and are much more commonly found in adolescence.
clinicalMeera Kotagal1:40 ↗
Femoral hernias are very rare in children, and as in adults, are more common in females.
epidemiologicalMeera Kotagal1:50 ↗
Indirect inguinal hernias in children are a congenital anomaly, meaning that they've occurred in development and are present at the time of birth.
clinicalMeera Kotagal2:10 ↗
Indirect inguinal hernias occur as a result of the failure of the processus vaginalis to fuse.
clinicalMeera Kotagal2:25 ↗
The right processus vaginalis usually obliterates after the left, which explains the higher prevalence of right-sided hernias.
clinicalMeera Kotagal2:45 ↗
The number one risk factor for inguinal hernias in children is prematurity.
clinicalMeera Kotagal3:30 ↗
More than half of the incarcerations that we see are in patients that are less than six months old.
epidemiologicalMeera Kotagal7:00 ↗
Two-thirds of incarcerations are in those patients that are less than a year.
epidemiologicalMeera Kotagal7:15 ↗
If the corrected gestational age is less than 60 weeks, premature patients are at a pretty increased risk of post-operative apnea, so you got to admit those patients after you do the repair.
clinicalMeera Kotagal7:30 ↗
One of the most important things in being able to reduce an incarcerated hernia is helping to keep the patient calm, sometimes that means pain control and sedation.
clinicalMeera Kotagal9:30 ↗
You have to keep applying pressure in a slow, gentle fashion and not just kind of come and go with your hands, because that gentle, slow pressure is what allows you to release the hernia.
clinicalMeera Kotagal10:20 ↗
If you can reduce an incarcerated hernia, then you want to go to the OR within the first 24 to 72 hours after the reduction.
clinicalMeera Kotagal11:30 ↗
Dr. Todd Ponsky states that with laparoscopy, you don't necessarily need to wait for bowel edema to come down because it's really not that much more difficult in a laparoscopic case if there's swelling, and sometimes the edema can help lift the peritoneum off.
Host summaryMeera Kotagal summarizing a resource — not the host's own clinical position12:10 ↗
Dr. Todd Ponsky suggests that if it's in the middle of the day and you have time availability and a patient has an incarcerated hernia, you could not even try to reduce it in the emergency room and just go straight to the operating room under laparoscopy.
Host summaryMeera Kotagal summarizing a resource — not the host's own clinical position12:45 ↗
The most important point in pediatric inguinal hernia repair is that you need to have high ligation of the processus vaginalis, whether you do it laparoscopically or open.
clinicalMeera Kotagal13:30 ↗
Unlike in adults, we don't generally use mesh in the repair of the pediatric inguinal hernia.
clinicalMeera Kotagal14:10 ↗
The outcomes between pediatric laparoscopic repairs and open repairs are thought to be similar, although there is some controversy on this topic.
opinionMeera Kotagal14:25 ↗
If you're considering that the child needs an orchidopexy in addition to their hernia repair, then most would approach that hernia in an open fashion.
clinicalMeera Kotagal14:55 ↗
A floor repair should be considered in children who have long-standing or very large hernias, where you note that the floor might be blown out or unsupported.
clinicalMeera Kotagal15:35 ↗
Superficial site infections occur in less than 1% of kids after inguinal hernia repair.
epidemiologicalMeera Kotagal16:25 ↗
The rates of recurrence after pediatric inguinal hernia repair vary from 1 to 5% depending on which studies you look at.
epidemiologicalMeera Kotagal16:40 ↗
In general, we don't try to limit activities in children after a hernia repair, and most children can return to normal activities within one to two days.
clinicalMeera Kotagal17:25 ↗
If a patient does have an undescended testicle that's palpable in the inguinal canal, then you should plan to do an orchidopexy at the time of your inguinal hernia repair.
clinicalMeera Kotagal19:45 ↗
Children with an absent vas deferens noted on hernia repair should be worked up for cystic fibrosis or for unilateral renal agenesis in the post-op period.
clinicalMeera Kotagal20:30 ↗
If patients are having significant testicular pain after a hernia repair, the thing that concerns you most is testicular ischemia, and the best way to evaluate that is to get an ultrasound looking for Doppler flow.
clinicalMeera Kotagal21:10 ↗
In general, patients with testicular ischemia after hernia repair are monitored and observed with pain control and we only frankly remove a necrotic testicle and not necessarily one that is partially ischemic.
clinicalMeera Kotagal21:40 ↗
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