Hernia unilateral 6 months

Unilateral hernia surgery in infants under 6 months India

Unilateral inguinal hernia (hernia on one side of the groin) is a normal condition among infants particularly premature babies as well as boys. It is a condition that results in a small sac of the abdominal lining (processus vaginalis) not closing effectively and, as a result, intestines or other tissues protrude through the inguinal canal.

Indication for Surgery

Instances of inguinal hernia in babies are always treated surgically since the hernia does not resolve on its own, and it has a high probability of incarceration or strangulation (when the intestine becomes trapped and loses its supply of blood).

Urgent surgery is needed if:

• The hernia is irreducible (irreducible).
• The baby presents with vomiting, swelling or discolouration in the groin.

Timing of Surgery

• Term babies: These infants are normally operated as soon as diagnosis is made, usually within few days to weeks.
• Infants born with premature or low-birth-weight: Surgery is usually postponed until the infants are medically stable and thus performed prior to discharge to avoid complications.
• Infants younger than 6 months: This is better done through early surgery repair preferably before the incarceration of this type of mobility.

Surgical Procedure

• Operation: Unilateral Inguinal Herniotomy.

Anaesthesia:

• It is normally done with general anaesthesia.
• Very small infants or preterm may be the ideal candidates to receive regional (caudal or spinal) anaesthesia to reduce respiratory complications.

Procedure Steps:

• The opposite side of the affected groin is incised (1.5 to 2 cm) small opening.
• The hernia sac is recognized and is cut off of the spermatic cord (in boys) or round ligament (in girls).
• It is ligated (tied off) at the bottom and removed.
• Absorbable sutures are used to close up the muscle and skin layers.
• Time: Approximately 30 and 45 minutes in the case of a unilateral repair.
• Hospital Stay: Day-care / 1-day stay (more in the case of preemies or medical infants).

Recovery and Aftercare

• The feeding may generally restart some hours after surgery.
• Incision takes 7-10 days to heal.
• The parents should look out of swelling, redness, or fever.
• The ability to resume normal activities (such as leg movement) can be achieved in a few days.
• Follow-up: 1 week and 1-3 months again.

Factors Affecting Infant hernia repair surgery cost India

This is a simple, straightforward account of cost motivating factors of infant (unilateral) hernia repair in India:

Type of hospital & city

• In metro cities, private tertiary/ multispecialty and international hospitals will be found to be more expensive than the trust/ government hospitals or those in smaller cities. One of the largest price drivers is location (Delhi, Mumbai, Chennai, Bangalore, Hyderabad, Kolkata, etc.). 

Experience and specialty of surgeon as a paediatrician

• The fees of a board-certified paediatrician surgeon or a very experienced consultant will tend to be higher than the one of a junior surgeon. Most parents seek the services of pediatric specialists when dealing with infants - this increases the cost. 

Anaesthesia - children anaesthetist and monitoring

• Babies require a paediatric anaesthesiologist, monitoring at birth, occasionally special airway/ventilation arrangements (below 6 months or preterm). The additional cost is the fee of anaesthesia and the additional monitoring (capnography, NICU standby).

Complexity of the medical condition of the baby

• Prematurity, low weight of birth, respiratory disease, Congenital cardiac conditions, or comorbidities all demand additional pre-op investigations, increased observation, or NICU support, all of which are an added burden to the bill. Such infants can be retained by the hospitals longer. 

Surgical methodology and supplies

• Open herniotomy (no mesh) is used in most cases of infant unilateral repair. When laparoscopic approach (not very common with infants very small) or specia consumables are involved, cost increased. Consumption (and branding) of any consumable e.g. suture, disposable, pack etc. billable. 

Length of stay / NICU / ICU usage

• An average, healthy infant can be day-care or 24-hour NICU/ICU; furthermore, overnight NICU/ICU care will cost a lot. The type of room (general or individual single room) is also important. 

Imaging Medications Pre-op tests

• Blood test, anaesthesia fitness test, glucose/ electrolyte monitoring (on neonates) and any pre/ post-operative medication are charged separately. They are bundled in some hospitals, and are itemized in others. 

Emergency and elective timing

• Repairs are generally more expensive (emergency/incarceration/strangulation) because there is an urgent OR occupied, there may be bowel manipulation, antibiotics, increased observation and increased anaesthesia/OT expenses. 

Follow up visit and complications

• Extra costs include post-op complications (infection, reoperation necessary). In some of the packages, a follow-up visit or removal of stitches is included; others are per-visit.

Inguinal hernia repair in infants under 6 months

• A case of inguinal hernia in infants is a condition whereby a small pouch of intestine or abdominal tissue slips through a weak point in the lower abdominal wall (inguinal canal).
• It is normally as a result of a patent processus vaginalis. It is a normal opening that is supposed to close after birth but in some babies it remains open.

More common in:

• Boys (in particular, preterm babies)
• Right side (unilateral) hernias, but 10-15% can be bi-lateral.
• Low or premature-weight births.
• Contrary to the case with older children or adults, infant hernias never go away on their own and they must be surgically removed.

When is surgery needed?

Emergency or rapid surgery is necessary since the infants are at a high risk of incarceration - when an intestine is trapped, causing:

• Vomiting
• Pain or irritability
• Groin swelling (hard, sore, or discoloured)
• Feeding difficulty
• When unattended to, it may result in strangulation (loss of blood) which is fatal.

Timing:

• Well and constant infants: Repair as soon as diagnosed (typically 1-2 weeks).
• Premature babies or those that are medically weak: These babies are medically stable but yet to be discharged.
• Immediate surgery is required in the case of the hernia becoming irreducible.

Best hospital for infant hernia surgery India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Pediatric unilateral hernia surgery India

Unilateral inguinal hernia is an abdominal protrusion in which the intestine or abdominal tissue is forced through a defect in the lower abdominal wall (inguinal canal) on one side.

Key facts:

• More prevalent in boys as compared to girls.
• Increased risk of preterm babies or low-weight infants.
• Does not go away, surgical intervention is the final cure.
• Medical emergencies are complications such as imprisonment (trapped intestine) and strangulation (loss of blood).

Indications for Surgery

• Surgery is required at all times after diagnosis.

Urgent surgery is needed if:

• The irreducibility of Hernia is not reducible.
• The child is in pain, vomits, swellings of the groin, or discolored.
• In stable children, elective surgery is done shortly after diagnosis and preferably before the development of complications.

Conclusion

Unilateral inguinal hernia in young children is a widespread phenomenon in infants and children, which must be corrected at the earliest undergoing surgery to avoid other complications such as incarceration and strangulation. The most common, safe and efficacious procedure is open herniotomy under general anaesthesia, having a short operative time and quick recovery. The prognosis is good, and the possibility of remission and recurrence is low in the case of a professional pediatric surgeon. Timely diagnosis and intervention, as well as post-operative care, will make the child continue his normal activities as soon and safely as possible.

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FAQ

Is a pediatric hernia self-limiting?

• No. Hernia in children cannot be spontaneously closed. The only definite one is surgery.

What kind of surgery is carried out?

• Infants and children are treated using open herniotomy. A groin incision is small and the hernia sac is tied off and removed and the incision sutured with absorbent sutures.

Is it safe to anesthetize infants and young children?

• Yes. Pediatric anaesthesia is quite safe particularly when provided by a pediatric anaesthesiologist. Special care is provided through special monitoring of the baby where there is safety during and after the operation.

Can laparoscopic surgery be done?

• Yes, laparoscopy repair can be done, yet, in infants below 6 months, open herniotomy is the norm because it is safe and easy to perform.

Will the hernia come back?

• Repeat is extremely (less than 2 percent) when it was done by a competent surgeon in pediatric surgery.