49496 Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; incarcerated or strangulated

Name of the Procedure:

Repair of Initial Inguinal Hernia in a Full Term Infant Younger than 6 Months, or a Preterm Infant Older than 50 Weeks Postconception Age and Younger than 6 Months, with or without Hydrocelectomy; Incarcerated or Strangulated Hernia Repair

Summary

This procedure involves surgical repair of an inguinal hernia in infants. An inguinal hernia occurs when a part of the intestine or fatty tissue pushes through a weak spot in the abdominal wall near the groin. This surgery is done to push the herniated tissue back into place and reinforce the abdominal wall. In some cases, it may include a hydrocelectomy, which addresses fluid accumulation.

Purpose

The procedure addresses inguinal hernias in infants, which can cause pain, complications, and impaired blood flow to the intestines. The primary goal is to correct the hernia and prevent any associated risks, such as incarceration (trapped hernia causing obstruction) or strangulation (cut-off blood supply to the herniated tissue).

Indications

• Visible or palpable bulge in the groin area, more noticeable when the infant cries or strains.
• Symptoms of pain or discomfort in the groin.
• Signs of an incarcerated or strangulated hernia (e.g., severe pain, vomiting, swelling).
• Preterm infants older than 50 weeks postconception, younger than 6 months, and full-term infants younger than 6 months.

Preparation

• The infant should fast for a specified period before the surgery as instructed by the healthcare provider.
• Pre-operative assessments may include blood tests and a physical examination.
• Parents will receive guidance on medication management for the infant pre-surgery.

Procedure Description

1. The infant is placed under general anesthesia.
2. A small incision is made in the groin area.
3. The surgeon pushes the herniated tissue back into the abdominal cavity.
4. The abdominal wall is reinforced, often with sutures.
5. If a hydrocele (fluid around the testicle) is present, it is drained, and the sac is closed.
6. The incision is closed with stitches or surgical glue.

Tools: Surgical instruments, sutures, possible use of mesh for reinforcement.

Duration

The procedure usually takes about 30 minutes to 1 hour.

Setting

Performed in a hospital operating room or a surgical center equipped for pediatric cases.

Personnel

• Pediatric surgeon
• Anesthesiologist
• Nursing staff specialized in pediatric care

Risks and Complications

• Infection at the surgery site
• Bleeding
• Recurrence of the hernia
• Damage to surrounding structures (e.g., testicle in boys)
• Anesthesia-related risks

Benefits

• Relief from pain and discomfort caused by the hernia.
• Prevention of serious complications like intestinal obstruction or loss of blood supply.
• Most infants recover quickly and can return to normal activities.

Recovery

• Post-operative care includes monitoring the infant for complications.
• Pain management with prescribed medications.
• Instructions on wound care and bathing.
• Follow-up appointments to ensure proper healing.
• Most infants resume normal feeding and activities within a few days to a week.

Alternatives

• Watchful waiting for non-incarcerated hernias (though surgery is typically recommended for infants).
• Delay surgery in less critical cases (though risk of incarceration remains).

Patient Experience

• During the procedure, the infant will be under general anesthesia and will not feel pain.
• Post-surgery, mild discomfort is expected, which can be managed with medications.
• Parents will receive guidance on how to provide comfort and care during recovery.