Pediatric Inguinal Hernia

Inguinal hernias in children are a result of failure of the processus vaginalis to obliterate leading to herniation of abdominal contents through the internal ring and into the inguinal canal. Most children are asymptomatic at presentation; however, some will present with acute incarceration with risk of strangulation. Diagnosis is based on physical examination. Ultrasound may occasionally rarely be helpful. Treatment is surgical with ligation of the hernia sac at the level of the internal ring. This can be completed electively unless the hernia is unreducible there is concern for incarceration or stangulation, at which time emergent repair is required. Inguinal hernia repair may be completed through an open or laparoscopic approach, based on surgeon preference. Assessment and repair of an asymptomatic contralateral patent processus vaginalis remains controversial.