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1/22/20091
Pediatric Surgery Care
Bby
By Susheewa Wichaikull
Hernia
•Uumbilical HerniaInquinal Hernia•Diaframatic HerniaHernia
The umbilicus ("belly button") is in the center of thelower abdomen. It is the site through which vesselsthat provide nutrients to the fetus from the motherduring development penetrate the fetal abdominalwall.miica ernias are airy common. ey areobvious at birth and are caused by a small defect inthe abdominal muscles which allows a portion of theperitoneum(lining of the abdominal cavity) toprotrude, and push the umbilicus outward.The defectis more obvious when the infant cries and theincreased pressureresults in more visible bulging.Most umbilical hernais are not treated surgically.In most cases, by about age
3
the umbilical herniashrinks and closes without treatment. The indicationsfor umbilical hernia repair include: incarcerated
Treatment
(strangulated) umbilical hernia defects notspontaneously closed by
4
to
5
 years of age childrenunder
2
with very large defects unacceptable toparents for cosmetic reasons
 
1/22/20092
Operation
While the infant is deep asleep and pain free(general anesthesia), a curved incision is madeunder the umbilicus.The hernia sac is identified, dissected fromthe underlying tissues, and cut out. The underlyingtissues are then closed with strong nonabsorbablesutures. Skin edges are held with paper tape(steri-strips). The surgical scar should be hiddenin the umbilical depression.Children can usually go home within one to two daysof an umbilical hernia repair. Recurrent umbilicalhernias are rare.Vessels that rovide blood to the testicle exit
Inquinal Hernia
the abdomen through a hole in the abdominal wall(inguinal ring). In women, this ring is also present,despite the absence of testicular vessels. In normalcases,the inguinal ring is small enough to preventthe passage of abdominal contents (such as the smallor large intestines) outside of the abdominal cavity
.
A hernia exists when the inguinal ring enlarges tothe point where a bowel can pass through it. Herniasmost often cause pain in the groin. Often, a lump isfelt in the groin area. This lump represents a bowelpassing through the inguinal ring. In most cases, thebowel is able to re-enter the abdomen on its own.Less frequently, the bowel becomes trapped outsideof the abdomen, leading to an incarcerated hernia.All inguinal hernias must be repaired. If not,a bowel passing through the inguinal ring becomestrapped and deprived of blood flow, leadingto a strangulated hernia.
 
1/22/20093
While you are awake and pain-free (using localanesthesia or spinal anesthesia) or asleep andpain-free (using general anesthesia), an incision ismade over the hernia. The bulging tissue or organis replaced inside of the muscle wall; the muscle. ,a small piece of synthetic mesh is used to close thedefect in the inguinal ring. Less commonly,laparoscopic surgical techniques are used to repairingunial herniasMoving and walking are recommended the dayof surgery. Small children do not require anyrestriction following a routine hernia repair.However, older children should avoid body-contactsports for atleast three weeksbecause a blowto the incision could burst the skin closure.Expect complete recovery from surgery in abouttwo to four weeks. Avoid heavy lifting or strainingfor several weeks after surgery. Avoid bathing forat least five days after the operation since soakingseparates the skin tapes, and the wound couldbreak open. Sponge bathing for infants andshowering for older children are permitted the dayafter surgery. Remember to carefully pat drythe wound tapes after showering.
Diaframatic Hernia
When the diaphragm develops with a hole init, the abdominal organs can pass into thechest cavity.
Treatment
An incision is made in the baby's upper abdomen,under the ribs. The abdominal organs are gentlypulled down through the opening in the diaphragm,and are positioned correctly inside of theabdominal cavity.
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