Male1: A very common call to a pediatrician, they feel a lump in the groin, on the other groin, a little bit way from the groin and if it a girl, particularly, he is worried about a thing called a femoral hernia and sometimes, he feels a lump and could actually be—is that true?
Male2: It is true, femoral hernias are pretty rare in kids. It is the inguinal hernia is the common one and the ovaries can certainly pop into a girl’s hernia for sure.
Male1: How would you advice someone at three o’clock in the morning you knew this was a problem and should they go to the emergency room if you thought there was something like that.
Male2: Well, hernias are very common. They need an operation and the reason they need an operation is because the bowels or the ovary can twist and lose its blood supply and if it is the ovary, you lose your ovary, not a good thing and if it is the bowels, you could lose your life. In the 19th century, people would die of this, and today, almost nobody dies of it because they get an operation. So if it is three in the morning on the phone, you would ask some questions, is the baby listless, is the baby happy? Is the baby sleeping? Is the baby uncomfortable? Is there a big lump that will not go away? If there is a big lump that will not go away with pain, that is an emergency. They have got to come into the emergency room.
Male1: Should the parents try to push the lump back in?
Male2: Look, if a little gentle pressure, if with warm bath you can work, you can spend a few minutes with that, if you can relieve it--
Male1: Not a force, but just a little gentle pushing?
Male2: Absolutely.
Male1: But not with force?
Male2: Right.
Male1: And if you do see that, it does not necessarily be fixed right away or can be put off—
Male2: If it is a hernia that comes and goes that is easily pushed back in, it is an elective operation. It is when you plan—if not effective for the child, gets a cold that day, you cancel it. Far and away, the most common operation a pediatric surgeon does, more often in boys than girls, 1% to 2% of term baby boys end up with a hernia, 20% of prematures, less common in girls, but it happens in girls too. I have probably fixed 4000 inguinal hernias and I still get a few years left in my career.
Male1: That is a very easy repair with kids, is it not?
Male2: It is not a complicated operation. It is not a life threatening operation. Like anything else, you would like to be in the hands of somebody who has done a few of whom uses a magnifying glass and takes it seriously and more important than that has a pediatric anesthesiologist because the baby’s life is in the hands of that anesthesiologist, especially with a small baby.
Male1: We do not hear bad stories of the anesthesia when it is a good pediatric anesthesiologist.
Male2: Very rare.
Male1: Very rare.
Male2: These things are ultimately in God’s hands, but you can minimize the risks if you have a well trained, conscientious pediatrician.
Male1: It always makes that situation better, is that true?
Male2: The surgeon has to have taken that person for lunch, getting them a cup of coffee. They would make a crack at it as possible. Without safe anesthesia, you cannot do pediatric surgery.
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