# Pediatric Inguinal Hernia in Brief: Presentation, Workup, Diagnosis, Perioperative Considerations — GCMD Library 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 Gerardo. Type: video · posted 2021-09-09 Canonical: https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457 ## Chapters - [0:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=0) Anatomy and Epidemiology - [6:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=360) Pathophysiology and Risk Factors - [12:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=720) Clinical Presentation and Differential Diagnosis - [18:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1080) Management of Incarcerated Hernias - [24:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1440) Surgical Approach and Technique - [30:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1800) Post-operative Care and Complications ## Statements - "Inguinal hernia repair is the second most common surgery performed by pediatric surgeons" — Meera Kotagal (epidemiological) [0:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=0) - "Indirect hernias are above the inguinal ligament but lateral to the epigastric vessels" — Meera Kotagal (clinical) [1:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=90) - "Direct hernias are above the inguinal ligament and medial to the epigastric vessels" — Meera Kotagal (clinical) [1:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=105) - "Femoral hernias are below the inguinal ligament" — Meera Kotagal (clinical) [2:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=120) - "The incidence of inguinal hernias overall ranges from about 1% to 5% in full-term newborns" — Meera Kotagal (epidemiological) [2:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=150) - "Incidence increases to about 13% in premature infants who are less than 32 weeks of gestational age" — Meera Kotagal (epidemiological) [2:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=165) - "Over 90% of hernias in children are indirect" — Meera Kotagal (epidemiological) [3:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=180) - "Direct hernias are pretty rare in children and are much more commonly found in adolescence" — Meera Kotagal (epidemiological) [3:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=195) - "Femoral hernias are very rare in children and are more common in females" — Meera Kotagal (epidemiological) [3:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=210) - "Indirect inguinal hernias in children are a congenital anomaly present at the time of birth" — Meera Kotagal (clinical) [4:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=240) - "Inguinal hernias occur as a result of the failure of the processus vaginalis to fuse" — Meera Kotagal (clinical) [4:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=255) - "The right processus vaginalis usually obliterates after the left, explaining the higher prevalence of right-sided hernias" — Meera Kotagal (clinical) [4:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=285) - "The number one risk factor for inguinal hernias in children is prematurity" — Meera Kotagal (clinical) [6:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=390) - "Risk factors include male sex, family history of inguinal hernias, history of undescended testicle or hydrocele, and connective tissue disorder" — Meera Kotagal (clinical) [7:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=420) - "More than half of incarcerations are in patients less than six months old" — Meera Kotagal (epidemiological) [12:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=720) - "Two-thirds of incarcerations are in patients less than a year old" — Meera Kotagal (epidemiological) [12:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=735) - "If corrected gestational age is less than 60 weeks, patients are at increased risk of post-operative apnea and should be admitted after repair" — Meera Kotagal (clinical) [12:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=750) - "Children with incarcerated hernia may present with pain, abdominal distension, or emesis if obstruction is present" — Meera Kotagal (clinical) [13:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=795) - "Patients with strangulated hernia may present with fever, tachycardia, leukocytosis, severe pain, or overlying erythema" — Meera Kotagal (clinical) [14:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=840) - "If you can reduce an incarcerated hernia, you want to go to the OR within 24 to 72 hours after reduction" — Meera Kotagal (guideline) [19:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1140) - "With laparoscopy, you don't necessarily need to wait for edema to resolve because it's not much more difficult and edema can help lift the peritoneum" — Meera Kotagal (opinion) [19:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1185) - "High ligation of the processus vaginalis is needed whether done laparoscopically or open" — Meera Kotagal (guideline) [22:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1320) - "Unlike in adults, mesh is not generally used in pediatric inguinal hernia repair" — Meera Kotagal (clinical) [23:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1380) - "Outcomes between pediatric laparoscopic repairs and open repairs are thought to be similar" — Meera Kotagal (clinical) [23:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1395) - "A floor repair should be considered in children with long-standing or very large hernias where the floor might be blown out" — Meera Kotagal (guideline) [24:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1485) - "Superficial site infection occurs in less than 1% of children after inguinal hernia repair" — Meera Kotagal (epidemiological) [26:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1575) - "Recurrence rates vary from 1 to 5% depending on which studies you look at" — Meera Kotagal (epidemiological) [26:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1590) - "Most children can return to normal activities within one to two days after hernia repair" — Meera Kotagal (guideline) [27:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1665) - "If a patient has an undescended testicle palpable in the inguinal canal, you should plan to do an orchidopexy at the time of inguinal hernia repair" — Meera Kotagal (guideline) [31:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1890) - "Children with absent vas deference noted on hernia repair should be worked up for cystic fibrosis or unilateral renal agenesis" — Meera Kotagal (guideline) [32:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1950) - "Testicular ischemia after hernia repair is best evaluated with ultrasound looking for Doppler flow" — Meera Kotagal (clinical) [33:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=2025) - "Patients with testicular ischemia are monitored and observed with pain control; only frankly necrotic testicles are removed, not partially ischemic ones" — Meera Kotagal (guideline) [34:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=2055) --- Not medical advice · citation policy: https://library.globalcastmd.com/ai