49492 Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; incarcerated or strangulated

Name of the Procedure:

Repair of initial inguinal hernia in a preterm infant younger than 37 weeks gestational age at birth, performed from birth up to 50 weeks post-conception age, with or without hydrocelectomy for incarcerated or strangulated hernias.

Summary

This surgical procedure corrects an inguinal hernia and, if needed, addresses associated hydrocele issues in preterm infants. The surgery is critical for preventing complications from a strangulated or incarcerated hernia, which occurs when tissue becomes trapped in the hernia sac.

Purpose

This procedure addresses inguinal hernias that are either incarcerated or strangulated in preterm infants. The goals are to:

• Relieve pain and discomfort.
• Prevent serious complications like bowel obstruction or loss of blood supply to trapped tissues.
• Correct the hernia and ensure proper healing, facilitating normal growth and development.

Indications

• Visible bulge in the groin or scrotum area.
• Symptoms of pain, vomiting, or irritability.
• Medical imaging showing incarcerated or strangulated hernia.
• Infants under 50 weeks post-conception age with a history of preterm birth.

Preparation

• Pre-operative fasting as instructed by the medical team.
• Discontinuation or adjustment of certain medications.
• Completion of diagnostic tests like ultrasound or MRI to assess the hernia.
• Pre-surgical examination by a pediatric surgeon to confirm the diagnosis and plan the procedure.

Procedure Description

1. The infant is given general anesthesia for comfort and immobility.
2. A small incision is made in the groin area.
3. The hernia sac containing the protruding tissues is identified.
4. Incarcerated or strangulated tissues are carefully reduced back to their correct position within the abdomen.
5. The hernia sac is removed, and the abdominal wall is reinforced.
6. If a hydrocele is present, excess fluid is drained and the hydrocele sac is removed.
7. The incision is closed using sutures or surgical glue.
8. The patient is monitored in recovery for any immediate post-operative complications.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The surgery is performed in a hospital's operating room, often in facilities specialized for pediatric care.

Personnel

• Pediatric surgeon
• Anesthesiologist
• Pediatric nurses
• Surgical technicians

Risks and Complications

• Infection.
• Bleeding.
• Recurrence of the hernia.
• Anesthesia-related risks.
• Injury to surrounding structures like the vas deferens or blood vessels.

Benefits

• Relief from symptoms such as pain and swelling.
• Prevention of serious complications from incarcerated or strangulated hernias.
• Typically, benefits are realized soon after recovery from surgery, allowing the infant to heal and grow normally.

Recovery

• Post-procedure monitoring in the hospital for 24 to 48 hours.
• Pain management with appropriate medications.
• Instructions for incision care and signs of possible complications to watch for.
• Follow-up appointments for surgical wound checks and overall well-being.
• Expected full recovery within a few weeks, but specific restrictions will be given based on the individual case.

Alternatives

• Non-surgical management might be considered in non-incarcerated, non-strangulated cases, but usually not recommended for incarcerated or strangulated hernias.
• Watchful waiting is rarely an option due to the risk of complications.

Patient Experience

• The infant will be under anesthesia and should not feel pain during the procedure.
• Post-operative discomfort can be managed with pain relief medications.
• Parents should be prepared for post-surgery care, which may include keeping the surgical site clean and monitoring for signs of complications. Pain management measures will also be advised by the healthcare team to ensure comfort during recovery.