From the Guidelines
Surgical repair is the recommended treatment for a reducible hernia in a 2-month-old infant to prevent complications like incarceration or strangulation. For most infants with inguinal hernias, prompt surgical intervention is necessary due to the high risk of complications if left untreated 1. The procedure, called herniorrhaphy, is generally safe and effective with a short recovery time.
Key Considerations
- While waiting for surgery, parents should monitor for signs of incarceration such as increased crying, vomiting, or a firm, painful bulge that cannot be pushed back.
- If these symptoms occur, immediate medical attention is necessary as this represents an emergency.
- No medications are typically prescribed for management of reducible hernias in infants.
- After surgery, acetaminophen (Tylenol) may be given for pain at a dose of 10-15 mg/kg every 4-6 hours as needed.
Post-Surgical Care
- Most infants recover quickly, usually within a few days, and can return to normal activities.
- Surgical repair is necessary because unlike some adult hernias, pediatric hernias will not resolve on their own and carry significant risk of complications if left untreated 1.
Additional Information
- The timing of the repair may depend on the specific circumstances, such as the infant's overall health and the presence of any other medical conditions.
- The use of laparoscopy and anesthetic approach may vary depending on the surgeon's preference and the infant's individual needs.
From the Research
Reducible Hernia in a 2-Month-Old
- A reducible hernia in a 2-month-old is a common condition that requires careful management 2, 3.
- The European Pediatric Surgeons' Association Evidence and Guideline Committee recommends a tailored approach to the management of inguinal hernia repair, taking into account the local facilities, resources, and expertise of the medical team involved 2.
- Laparoscopic repair may be beneficial for children with bilateral hernia, and preterm infants may benefit from using regional anesthesia and postponing surgery 2, 3.
Treatment Options
- Laparoscopic repair is a viable alternative to open repair and offers several benefits, including superior visualization of the relevant anatomy, ability to assess and repair a contralateral hernia, and lower rates of metachronous hernia 3.
- Open repair is still a commonly used technique, especially in cases where laparoscopic repair is not feasible or safe 4.
- The choice of operative strategy (open vs laparoscopic) depends on surgical costs and postoperative quality of life 5.
Complications and Outcomes
- Irreducible inguinal hernias constitute 1.6% of the workload on inguinal hernia repair, and the hernia sac contains in males most frequently small bowel and in females exclusively a prolapsed ovary 4.
- Significant comorbidity is present in 18% of cases, and laparoscopic and open techniques complement each other in addressing the issue 4.
- The management of reducible ventral hernias, including repair at diagnosis versus watchful waiting, depends on various factors, including the risk of perioperative mortality and recurrence 5.