Male2: There is that the blood supply either to the testes itself or the blood supply to the intestine can be kinked by the intestine stuck in the processus vaginalis, in the hernia sac. And either the testes can be damaged or die, or a loop of intestine can be damaged and die. So when we have a baby who has what we know to be an inguinal hernia rather than a hydrocele, we would schedule a surgery to fix it hoping to repair it before it incarcerates, before the intestine gets stuck.
Male1: If a child has an inguinal hernia on one side, what are the chances of having it in the other side?
Male2: The answer is that it depends at what age the baby first presents with an inguinal hernia. If you have a premature baby who in the nursery has an inguinal hernia on one side, it is virtually a hundred percent certain that there is a hernia on the second side, even if you do not see it, so when we operate on premature babies with hernias, we almost always on both sides. If you have a full term baby, that risk maybe down to 96% or 97% and as you get older and older, the chance that there is a hernia on the asymptomatic side, in other words, baby presents with a hernia on one side, but nothing on the other that you can see or feel; the chance that there is a hernia on the side where you see nothing drops, so if a baby has not had a hernia that anybody has seen, mother changing diapers, father changing diapers, pediatrician and the baby gets to age one and a hernia appears, the risk that there is a hernia on the asymptomatic side is about 60%. At age two, the risk is about 40%. So pediatric surgeons have over the course of time come to slightly different decisions and have slightly different opinions about what the right thing to do is. I think that it is safe to say that the majority of pediatric surgeons probably three-quarters of pediatric surgeons would operate on both sides of this tiny baby who has an inguinal hernia. The reason for this debate and the discussion is you are making a balanced judgment about two different risks. The risk that there is a hernia that is there that is going to need an operation at some point anyway, meaning another trip to the operating room, another anesthetic, versus what is the risk of doing two sides at once and the answer is the risk of doing two sides at once is relative. Every time a surgeon makes a cut, there is a risk of infection, small risk, but a true risk. A risk of bleeding, a risk of injury to some surrounding tissue, so even though the risk is small, we always have to balance that risk of doing an operation, which may or may not be necessary against the risk of having a hernia that then will require being fixed later. Nowadays, there are some surgeons who actually do a laparoscopic exploration of the contralateral side. What that means is that if they are operating on a hernia, they take a little telescope, much smaller than this pen I am holding and I will show you a picture. What they do is they stick the telescope into the baby’s belly through the side where the hernia is, through the little hole and they look on the inside to see if there is an opening on the other side. Some surgeons do not do that because they feel that the visualization, the view through that telescope at that angle is not so good and so they would rather just judge on physical exam or there are even a few surgeons that there is no reason to ever explore the other side unless a hernia actually appears. So there is some debate about in which situation you fix both sides rather than just one side. Now as a general rule, repairing an inguinal hernia in a child is a pretty straightforward operation. It takes about half an hour of operating. It is a relatively straightforward operation. The risks are the risks of any operation. As I have mentioned, there is a risk of infection, surprisingly small, much less than 1%. There is some risk of damage to the blood vessels and the vas deferens which go to the testis on that side. Again that risk is much less than 1%, but it is a risk, and there is some risk of bleeding, again a tiny risk, but it is a concern because sometimes babies have problems with their coagulation with the way their body controls bleeding and because they are little babies, they have not had accidents yet, they have not been to dentists yet and so, that problem with their bleeding may not be discovered until they go to the operating room.
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