What happens if no therapy is given?
An inguinal hernia does not resolve spontaneously and requires surgery to correct it. If left alone, without opting for surgery, there are many complications that are known to occur. Irreducibility - when the intestines come out when the child is crying or straining but do not go back into the abdomen. This will give rise to pain, blocking of the lumen of the intestines that are in the passage and intestinal obstruction with abdominal distension, vomiting.(Fig) If not relieved, this can further lead to compression of the blood vessels of the bowel caught in the passage and gangrene of the intestines. A unique complication that occurs in infants is that the intestines in the passage press against the blood vessels of the testis and cut off the blood flow to the testis resulting in a black testis that needs to be removed. (Fig)


Complications result in the need for surgery as an emergency and not only is the surgery more difficult but the chances of complications after this surgery are also much higher. This can be avoided if the surgery is done electively. The ideal time for surgery to be finished is as soon as possible after the diagnosis is made. Age and weight are no criteria for postponing the surgery. Once a definitive diagnosis of hernia is made, surgery should be planned within 15 - 20 days.

Surgery is done usually as a day care case, and the child can go home the same day or in case of infants the next day. In surgery, the inguinal region is exposed through the incision, the sac or the patent passage is identified and carefully separated from the vessels and the vas deferens going to the testis and is tied off as close to the abdominal cavity as possible. The technical difficulty in children is that the structures going to the testis are very tiny, delicate and a slight jerk or pull is adequate to break or tear them and cause irreversible damage that will be known years after the damage has been done to the function. Also the sac of the hernia in children can be very thin and easily torn if not done delicately.