The testes originally develop in the back of the abdominal cavity of the foetus.
Later they descend to the scrotum. During their passage out of the abdomen they
drag with them a sleeve of peritoneum, the thin membrane that lines the
abdominal cavity. This sleeve is present on both sides, the left and the right.
Once the testes are placed in the scrotum at birth this sleeve-like connection
with the abdominal cavity closes off. If it doesn't close off, then fluid from
the abdomen may trickle down into the extension of peritoneum to produce a
balloon like swelling in the scrotum. This is a hydrocoele. If the connection
with the abdominal cavity is wider, then even intestinal loops descend down
producing a swelling in the groin called hernia. Hernias and hydrocoeles are
very common in children.
What are the symptoms?
The parents will notice a swelling in the groin or the scrotum. The swelling may come and go. It is usually more prominent when the child cries or strains, or later in the day. This is because any factor that increases abdominal pressure is likely to increase the swelling. Since crying increases the swelling, the parents often feel that the swelling is the cause of pain. This is not true, as the swelling does not cause the child any discomfort as long as it goes in and out.
Sometimes in hernias, the intestines come out but fail to go back inside and get stuck in the hernial sac. This produces a painful tender swelling and the child becomes irritable and vomits. This is an emergency, and if the child is not immediately operated upon the intestinal loop may die and will have to be removed. No such emergency happens in cases of hydrocoele which contains only fluid.
What is the treatment?
Hydrocoeles are commonly present in infants. In a number of them, the sac obliterates on its own in the first one or two years of life. Therefore, hydrocoeles need not be operated upon during this age unless they become very large and show no sign of spontaneous closure.
Hernias on the other hand need to be operated as early as possible after the diagnosis is made. This is because of the intestines getting stuck. The operation is performed under general anaesthesia and usually lasts 30-45 minutes. During the operation, the connection with the abdominal cavity is tied off. The operation for hernia and hydrocoele is identical and is called herniotomy. The baby is able to feed shortly after the operation and there are no special restrictions on activity unlike similar operations in adults. The operation is performed as a day care procedure and admission to hospital is not required except in very small babies. With the new technique a waterproof dressing allows the baby to be bathed and the wound is repaired with absorbable stitches that do not need to be removed.
There is at present no role of treatment of hernias in children using the laparoscopic technique that is so popular in adults.
What are the complications?
Even little babies can be safely operated upon for hernia, but this needs to be done by surgeons who have the experience of operating on babies. Sometimes there may be a little swelling in the scrotum after the operation, but this subsides in about a week. In 2% cases the hernia may reappear. In 10% children, a hernia may develop on the opposite side, not because of the operation but because the communication might have existed on that side as well but had not manifested earlier. If this does happen, then the other side will also need an operation.