What is Open Hernia Repair in Children

Open hernia repair is a surgical procedure to fix a hernia. A hernia occurs when an internal organ or tissue pushes out through a weak spot in the abdominal wall muscles.

Hernias in children often happen at the belly button (umbilicus) just above the area where the abdomen joins the upper thigh (groin). This type of hernia is called an inguinal hernia.

Most hernias tend to get worse over time. Often, surgery is done to prevent the hernia from becoming bigger, uncomfortable, or an emergency. Emergency surgery may be needed if abdominal contents get stuck in the opening (incarcerated hernia) or the blood supply gets cut off (strangulated hernia). In an open repair, an incision is made in the abdomen to perform the surgery.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Long-lasting (chronic) pain.
• Bleeding.
• Infection.
• Damage to the testicle. This can cause shrinking or swelling.
• Damage to the bladder, blood vessels, intestine, or nerves near the hernia.
• Trouble passing urine.
• Allergic reactions to medicines.
• Return of the hernia.

What happens before the procedure?

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water or clear fruit juice.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating foods.
• 6 hours before the procedure – have your child stop drinking formula or milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking clear liquids.

Medicines

• Ask your child’s health care provider about:
  • Changing or stopping regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do not let your child take these medicines before the procedure if your child’s health care provider instructs you not to.
• Your child may be given antibiotic medicine to help prevent infection.

General instructions

• Your child may have blood tests or imaging studies.
• Ask your child’s health care provider how the surgical site will be marked or identified.
• Let your child’s health care provider know if your child develops a cold or any infection before the procedure.
• Plan to take your child home from the hospital or clinic.
• If your child will be going home right after the procedure, plan to be with your child for 24 hours.

What happens during the procedure?

• To reduce your child’s risk of infection:
  • Your child’s health care team will wash or sanitize their hands.
  • Your child’s skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your child’s veins.
• Your child will be given one or more of the following:
  • A medicine to help your child relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make your child fall asleep (general anesthetic).
• Your child’s surgeon will make an incision over the hernia.
• The tissues of the hernia will be moved back into place.
• The edges of the hernia may be stitched together.
• The opening in the abdominal muscles will be closed with stitches (sutures).
• The incision will be closed.
• A bandage (dressing) may be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines your child was given have worn off.
• Your child may be given medicine for pain.
• If your child is of driving age, do not let your child drive for 24 hours if he or she was given a sedative.

Tell your child’s health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or family members have had with anesthetic medicines.
• Any blood or bone disorders your child has.
• Any surgeries your child has had.
• Any medical conditions your child has, including any recent cold or flu symptoms.

Care After Open Hernia Repair in Children

This sheet gives you information about how to care for your child after the procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your child’s health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Mild discomfort.
• Slight bruising.
• Minor swelling.
• Pain in the abdomen.

Follow these instructions at home:

Incision care

• Follow instructions from your child’s health care provider about how to take care of the incision area. Make sure you:
  • Wash your hands with soap and water before you change the bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change the dressing as told by your child’s health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your child’s health care provider tells you to do that.
• Check your child’s incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Until your child’s health care provider approves.
  • Do not let your child lift anything that is heavier than 10 lb (4.5 kg).
  • Do not let your child play contact sports.
• Let your child return to his or her normal activities as told by your child’s health care provider. Ask your child’s health care provider what activities are safe. Your child should not climb or play roughly until your child’s health care provider approves.
• If your child is of driving age:
  • Do not let your child drive for 24 hours if he or she was given a sedative.
  • Do not let your child drive while taking prescription pain medicine or until your child’s health care provider approves.
• Do not let your child use heavy machinery while taking prescription pain medicine.

General instructions

• To prevent or treat constipation while your child is taking prescription pain medicine, your child’s health care provider may recommend that you make sure your child:
  • Drinks enough fluid to keep his or her urine clear or pale yellow.
  • Takes over-the-counter or prescription medicines.
  • Eats foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limits foods that are high in fat and processed sugars, such as fried and sweet foods.
• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Do not let your child take baths, use swimming pools, or use a hot tub until your child’s health care provider approves.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has more redness, swelling, or pain around the incision.
• Your child has more fluid or blood coming from the incision.
• Your child’s incision feels warm to the touch.
• Your child has a bad smell coming from the incision.
• Your child has a fever or chills.
• Your child has not had a bowel movement in 2–3 days.
• Your child’s pain is not controlled with medicine.
• Your child has blood in is her or her stool.

Get help right away if:

• Your child has chest pain or shortness of breath.
• Your child feels light-headed or feels faint.
• Your child has severe pain.
• Your child vomits and his or her pain is worse.
• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.