Paediatric Surgeon
Hernias in Children
What is a Hernia?
A hernia describes a small piece of abdominal lining, and sometimes section of the bowel, which bulges out through a weak area in the muscles of the abdominal wall. Both children and adults can have hernias. Sometimes a hernia is present at birth. The hernia can look bigger when your child cries or strains. You may hear your child's hernia referred to as 'inguinal hernia' or a 'femoral hernia': these names refer to the exact part of your child's abdomen which have muscle weakness. Both types of hernia are treated the same way.
How common are hernias in children?
Hernias are more common in boys than girls. About one in 50 boys will have a hernia during their childhood. The condition is also more common in babies born prematurely.
Is it possible to prevent a hernia?
There is no known way of preventing a hernia.
How is a hernia diagnosed?
It is possible to diagnose the hernia by clinical examination, as it appears as a characteristic lump in your child's abdomen. Your child may not need any further diagnostic investigations.
How are hernias treated?
Your child will need a small operation. In many cases this can be carried out as day surgery - your child will arrive at the hospital, have the operation and be able to go home on the same day. Occasionally a chid will need to stay in hospital for two or three days.
What happens before the operation?
You will receive information about how to prepare your child for the operation in your admission letter. Your child should not have anything to eat or drink beforehand for the time specified in the letter. It is important to follow these instructions, otherwise your child's operation may need to be delayed or canceled.
The day you come to hospital for the operation, Mr. Clarke will explain the operation in detail, discuss any worries you may have, and ask you to sign the consent form. An anaesthetist will also see you to explain the anaesthetic in more detail. If your child has any medical problems, such allergies, please tell the doctor.
What does the operation involve?
Your child will be given a general anaesthetic and will be asleep during the operation. Mr. Clarke will make a small cut over the bulge in the lower abdomen. The abdominal lining and piece of bowel will be pushed back into place. The muscle wall will be repaired and the cut will be closed with stitches. These stitches will dissolve and will not have to be removed. The inspection of the other groin maybe also offered as in 10% of cases this can occur. This involves a small 3mm telescope pass through the hernia to inspect the opposite side. If there is a hernia, this will be repaired at the same time.
Are there any risks?
Every anaesthetic carries a risk of complications, but this is very small. The anaesthetist is an experienced doctor who is trained to deal with any complications. After an anaesthetic, a child sometimes feels sick and vomits, has a headache, sore throat, or feels dizzy. These effects are usually short-lived. Any surgery also carries a small risk of infection or bleeding.
What happens afterwards?
After the operation, your child may feel some tenderness and have bruising in the groin area, but this is not unusual.
If your child feels uncomfortable, a painkiller such as liquid paracetamol will help. It is a good idea for your child to wear loose clothing while the area is sore. Babies can wear nappies as usual. You can give your child a bath two days after the operation. However, avoid long baths until the wound has settled down. Do not use cream around the wound, as it may cause irritation.
Mr. Clarke may ask you to come back for an outpatients appointment. In the meantime, the hospital will contact your GP to tell them about the operation.
Are there any long term effect of hernia repair?
Most hernia repair operations are successful. You should see an immediate reduction or the complete disappearance of the hernia.
Undescended testicles
What are undescended testicles?
This is when your child's testicles are not in their usual place in the scrotum. While your child is the womb, the testicles are developing inside his abdomen. Towards the end of the pregnancy, the testicles travel through a passage into the scrotum. Both testicles should be in the scrotum by the time your child is one year old. Generally, only one of the testicles is affected, but on rare occasions both testicles fail to travel to the scrotum.
In some children, the testicles may be in the scrotum for much of the time but cannot be felt there because they naturally raise back into the body through fear or cold temperatures. You can usually find this out by putting your child in a warm bath and checking whether you can feel both testicles. If this is the case there is no cause for concern.
What are the symptoms of undescended testicles?
Usually there will not be any symptoms at all, other that not being able to fell the testicles in the scrotum. Your child will not be in pain, and the undescended testicles will not interfere with any bodily function.
However, if one of the testicles becomes twisted (testicular torsion), this will be painful, either in the groin or the abdomen, depending on the location of the testicle at the time.
How are undescended testicles diagnosed?
Your child's doctor will need to determine whether the testicles are truly undescended or whether they have slid back into the body temporarily. This is usually done by feeling the abdomen and the scrotum.
What causes them?
On rare occasions, the testicle does not descend due to other problems with the testicles themselves or with the male hormones.
We do not know exactly why this happens, but it is not due to anything that happened during pregnancy.
How common are they?
This condition is more common in premature babies. Around 1 in 20 male babies is born with an undescended testicle. In about 1 in 70 cases the testicle remains undescended.
How are undescended testicles treated?
The method of treatment depends on the suspected cause. However, whatever the cause, undescended testicles are best treated in early childhood. Your child's testicles will need treatment as they do not seem to mature properly if left in the abdomen. The amount of sperm and fertility levels seem lower in men who have undescended testicles, and ever lower if they were not treated early in childhood. This is because the testicles need to be a few degrees cooler than the rest of the body to produce sperm. It is also impossible for men with undescended testicles to check for testicular cancer, as the testicles cannot be felt in the abdomen. If the testicles are left in the abdomen, this also increases the risk of testicular torsion.
If the doctors suspect the testicles have not descended due to a hormone problem, they may suggest a short course of a hormone called chorionic gonadotrophin (hCG). If the doctors do not suspect a hormone problem, or if the testicles remain in the abdomen after the hormone treatment, your child will need a short operation under general anaesthetic call an orchidopexy.
What is an orchidopexy?
This is an operation to bring the testicles down from the abdomen to their usual place in the scrotum. This is a short operation under general anaesthetic, lasting about 45 minutes. In many cases, this can be as day surgery: your child will arrive at the hospital, have the operation, and be able to go home on the same day. Occasionally a child will need to stay overnight.
What happens before the operation?
You will receive information about how to prepare your child for the operation in your admission letter and welcome booklet. Your child should not have anything to eat or drink beforehand for the amount of time specified in the letter or the telephone call. It is important to follow these instructions, otherwise your child's operation may need to be delayed or even cancelled.
On the operation day, your child's surgeon will explain the operation in more detail, discuss any worries you may have, and ask for your permission for the operation by asking you to sign a consent form. An anaesthetist will explain your child's anaesthetic in more detail. If your child has any medical problems, such as allergies, please tell the doctor.
What does the operation involve?
The orchidopexy can either be carried out using traditional open surgery or keyhole surgery. The surgeon will move the testicle down into the scrotum and close up the passage through which the testicle should have travelled to stop the testicle moving back into your child's abdomen.
On rare occasions, the surgeon will find that the testicle has not formed properly or has been damaged while in the abdomen. If this is the case, the surgeon will remove the damaged testicle and might secure the healthy one in the scrotum to ensure that your child's remaining testicle stays in place and can develop in the normal way. Sometimes it takes two operations to bring the testicle to the correct place.
Are there any risks with the operation?
Every anaesthetic carries a risk of complications, but this is very small. Your chid's anaesthetist is an experienced doctor who is trained to deal with any complications. All surgery carries a small risk of infection or bleeding. After the operation there will be some tenderness in the groin area. Occasionally the may be some bruising. There is a small chance that the testicle may be damaged during the operation. This is more likely to occur if the testicle could not be felt while in the abdomen.
What happens afterwards?
Your child will come back to the ward to recover, and will be able to go home once he has had something to eat and drink, and is comfortable. We will telephone you the following day to check your child is making good recovery. Please tell the nurse the best time to contact you before you leave the ward.
Your child may fell sick for the first 24 hours. You should encourage, but not force, him to drink plenty of fluids. It does not matter if he does not fells like eating for the first couple of days, as long as he is drinking plenty of fluids.
Your child will have been given pain-relieving medications during the operation, but these will begin to wear. Your child will need to have regular pain relief for at least three days, and we will give you the medications to take home with you. As well as the medications, distracting your child by playing games, watching TV, or reading together can also help your child's mind off the pain.
Your child's groin will probably feel sore for a while after the operation, but wearing loose clothes can help. The stitches used during the operation will dissolve on their own so there is no need to have them removed. If possible, keep the operation site clean and dry for two to three days to allow the operation site to heal properly. If your child needs to have a bath or shower, do not soak the area until the operation site has settled down. Your child should not ride a bicycle or other sit on toy for one month after the operation, to prevent the testicles from travelling back up into the abdomen.
Your child should be able to go back ti school within a couple of days, when he is more comfortable.
Your and your child will need to come back to hospital for an outpatient appointment about three months after the operation. We will send you the appointment date in the post.
You should call your GP, the ward, or Mr. Clarke's secretary if:
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Your child is in a lot of pain and pain relief does not seem to help
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Your child is not drinking any fluids after the first day back home
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The operation site is red or inflamed, and feels hotter than the surrounding skin
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There isa any oozing from the operation sit
What is the outlook for children with undescended testicles?
When the undescended testicles are treated in early childhood, the outlook is good. Your child will have normal fertility levels unless there were problems with the testicles themselves. If a damaged testicle was removed, leaving one healthy testicle, this should not affect your child's fertility levels in later life to any great degree.
Foreskin Surgery
Neonatal Circumcision
This procedure is carried out anytime between birth and 8 weeks of age without general anaesthetic. The procedure safely removes the foreskin under a local anaesthetic block. A sutured repair is used to ensure excellent cosmetic result. All sutures dissolve within two weeks. You are able to be discharged with your baby straight away after the procedure. A dressing is worn overnight to ensure comfort and this is easily removed the following day. Anaesthetic gel is given to go home, but this is rarely needed. A follow up call is made the following morning to ensure all is well.
The procedure can be carried out usually on a day of your choice at any of the centres Mr Clarke operates. The consultation and procedure happen on the same day.
Circumcision in an older boy
This is carried out under general anaesthetic and requires several days off from usual activity. The pain is usually the most worrying aspect for any parent tough, with a local anaesthetic block and pain killer, this is kept to a minimum after the operation. Most boys return to normal activity within 48 hours after the procedure.
Preputioplasty
This is a widening of the natural preputial ring if tight and difficult to retract. This is carried out around 8 - 16 years of age and is also under general anaesthetic. 3 - 5 fine sutures are used which dissolve after 2 weeks.