22. HerniaTalk LIVE Q&A: Pediatric Hernias
With Dr. Todd Ponsky · hosted by Dr. Em Gootee & Dr. Todd Ponsky
Part of
Umbilical Hernia 7 items
Chapter 1 of 7 · Fundamentals
Introduction
Introduction and Overview of Pediatric Hernias
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Pediatric Hernia: Update Course 2013
52 min · Published Jul 2017
Video
Groin Controversies: Update Course 2016
Dr. Todd Ponsky · 28 min · Published Jul 2017
Video
Focus on Technique- Laparoscopic Pediatric Hernia Repair 2015
Dr. Todd Ponsky · 140 min · Published Mar 2014
Podcast
Inguinal Hernias: Diagnosis and Management
16 min · Published Apr 2021
Video
2026 Laparoscopic Pediatric Hernia Repair
123 min · Published Jun 2026
Video
Laparoscopic Pediatric Hernia Repair: Online Course 2017
Dr. Todd Ponsky · 102 min · Published Aug 2017
Video
Acute Cholecystitis
Todd Ponsky · 32 min · Published Jul 2026
Video
Update Course Rewind 2025: Updates in NEC Management
11 min · Published Jul 2026
Video
Journal of Pediatric Surgery Article Review: February 2022 - BAPS Issue
Todd Ponsky · 11 min · Published Jul 2026
Video
Journal of Pediatric Surgery Article Review: September 2021
Todd Ponsky · 11 min · Published Jul 2026
Video
Adolescent Surgery Session: They Look Like Adults, but Aren't the Same-Hernia Repair
Todd Ponsky · 18 min · Published Jul 2026
Video
Pediatric Pre-Operative Bowel Prep
Todd Ponsky · 1 min · Published Jul 2026
What the experts said
Hernias in children are one of the most common operations pediatric surgeons perform, along with appendicitis.
There are three types of hernias children get: inguinal hernias in the groin, umbilical hernias in the belly button, and epigastric hernias in the top of the abdomen.
Every pediatric surgeon is a hernia specialist.
The structures in tiny neonates are very fragile, prompting exploration of less invasive laparoscopic repair techniques that avoid manipulating the structures.
A study found that vicryl suture (dissolvable stitch) takes several months to dissolve, not just 3 weeks as expected.
80% of umbilical hernias will close spontaneously by the time the child is 3 to 5 years of age.
A study showed that umbilical hernias repaired under age 3 have a higher chance of recurrence, with age 4 being the optimal repair age.
The incidence of umbilical hernia incarceration (intestines getting stuck) is probably less than 2%, making it safe to wait for repair.
For a child, an umbilical hernia repair is basically 4 stitches, they go home and are out playing the next day.
If an umbilical hernia is not repaired and grows larger in adulthood, mesh material may be required, making it a more complicated operation.
The chance of inguinal hernia incarceration in premature newborns is 30% (1 out of 3 babies).
Once children reach about 1 year of age, the inguinal hernia incarceration rate drops to the same level as adulthood, which is very low (less than 1%).
A case was presented where a hole seen during an appendix operation was left unfixed because it was asymptomatic and a dirty operation; 5 years later the hole was gone, suggesting some inguinal hernias may close spontaneously.
During the third trimester, testicles or ovaries drop from high in the abdomen down into the pelvis (ovaries) or through the abdominal wall into the groin (testicles), creating a canal that normally closes behind them.
When babies are born early (premature), the canal created by descending testicles may not have time to close, allowing intestines to follow that path and creating a hernia.
The original laparoscopic hernia repair had a 3-4% recurrence rate, but improved techniques have reduced this to less than 1%.
A baby hernia is fundamentally different from an adult hernia—it's not a muscle problem but a persistent thin peritoneal tissue path between normal muscles.
The pediatric hernia operation involves removing the thin peritoneal tissue, allowing the muscles to close naturally without need for mesh reinforcement.
If a pediatric hernia repair fails, it's easy to fix again, and the chance of failing twice is extremely low unless the child has a connective tissue disorder.
Umbilical hernia recurrence is even more rare than inguinal hernia recurrence and usually means a stitch broke or knot came untied.
In the adolescent population, the pediatric hernia repair (open or laparoscopic) has a recurrence rate of less than 2%.
Direct hernias in children are extremely rare; in 20 years of practice, only one case was seen, likely caused by surgical injury to the thin floor during a previous operation.
Laparoscopic repair avoids manipulation of the thin inguinal floor, theoretically preventing iatrogenic direct hernias that can occur with open repair.
The pediatric inguinal hernia repair is typically a high ligation—finding the peritoneal tissue, tying it off at its origin, and removing excess tissue—not a muscle repair like Shouldice or Bassini.
A Marcy repair (one stitch to reinforce muscle weakness) is sometimes added but unusual in pediatric cases.
Braided permanent sutures can cause reactions and infections when placed close to skin in open inguinal hernia repairs, so most surgeons use dissolvable stitches for open repairs.
The incidence of anesthesia-related mortality in children is less than the chance of being struck by lightning or hit by a car walking down the street.
In tiny babies, transverse (left-to-right) abdominal incisions have a lower incisional hernia rate than midline (up-and-down) incisions because the muscles aren't yet strong and formed.
Children can get incisional hernias, and in tiny babies the rate may be higher than in adults due to weak, unformed muscles.
Pediatric incisional hernias are usually repaired primarily (tissue repair) first, unlike adults where mesh is typically used.
Mesh is avoided in growing children because as the child grows, the mesh will get distorted, move off to the side, and no longer cover the intended area.
The pediatric primary inguinal hernia repair (high ligation) has a less than 1% recurrence rate, working very well without mesh even in adolescents.
Placing mesh in the groin of a child who hasn't been through their fertile years could theoretically injure the spermatic cord and affect fertility.
Mesh works by causing scarring to create a scaffolding, which could involve the spermatic cord in that scarring process.
Pediatric surgeons perform single-port laparoscopic appendectomies through the umbilicus, removing the appendix through a single incision and sending patients home from the recovery room without overnight stay.
Incisional hernias can occur after laparoscopic operations when the 10-12mm umbilical extraction site is closed with dissolvable stitches that break or dissolve too soon.
Mesh is used in pediatric surgery for congenital diaphragmatic hernias when edges cannot be brought together, and for abdominal wall defects like omphalocele and gastroschisis when primary closure is impossible.
Biologic mesh doesn't work very well in pediatric surgery; when bridging is needed, polypropylene or Gore-Tex mesh is typically used.
Sports hernias are not true hernias but ligamentous tears from aggressive sports, treated with 6-8 weeks of rest and physical therapy rather than surgery.
Epigastric hernias are defects in the top of the abdomen where only fat pokes through (partial thickness, not full abdominal wall), and many surgeons now trend toward not fixing them because they're more cosmetic.
When an asymptomatic inguinal hernia is found incidentally during another operation, it is typically not repaired at that time because many people have these holes their whole life without problems.
20% of children with one inguinal hernia have a hernia on the other side as well.
A hydrocele is a type of hernia where the canal closed almost completely after the testicle descended, leaving only a microscopic hole that allows fluid but not intestines to pass through.
Hydroceles are not dangerous and mainly a cosmetic problem, though some wonder if the bathing fluid could cause fertility issues; most resolve spontaneously so repair is delayed until older age.
Undescended testicles are associated with hernias and are a problem because testicles need to be in the cooler scrotum; staying high by the abdomen can cause infertility and slightly increased cancer risk.
Undescended testicles are repaired by 6 months to 1 year of age, but many come down spontaneously when observed after birth.
Retractile testicles don't need surgery—the muscles are too strong and pull small testicles up, but they can be easily pulled down manually and will fall normally as the child grows.
There is absolutely a familial component to hernias, though it doesn't follow exact autosomal dominant or recessive genetic distribution patterns.
Hiatal hernias are very common in newborns (who vomit frequently due to large hiatal hernias) and get better with time, so surgery is avoided unless the baby cannot feed.
The pendulum on hiatal hernia surgery has swung—previously one of the highest-volume procedures, pediatric surgeons have recently backed away from operating on as many.
New research suggests there may be long-term deleterious effects of anesthesia in babies under age 2, leading to a shift in pediatric surgery to avoid elective operations under age 2-3 unless urgent.
Multiple studies have shown the laparoscopic inguinal hernia repair recurrence rate is less than 1%.
A Mayo Clinic 50-year follow-up study found that the small number of patients requiring re-operation after pediatric hernia repair had developed a direct hernia (adult type), suggesting a new hernia rather than true recurrence.
A New England Journal paper suggests multiple anesthetics in babies under age 2 may cause neurodevelopmental effects noticeable in adulthood, though this finding is unclear and will be refuted soon.
Due to uncertainty about anesthesia effects, the new policy for most U.S. pediatric surgeons is to avoid elective operations until age 2-3 unless urgent.
A South American study showed that wrapping the spermatic cord with peritoneum from the hernia sac to protect it from mesh resulted in dramatically better pre- and post-operative sperm studies compared to unprotected synthetic mesh.
A pediatric study from approximately 3 years ago found that in children, the female genetic lineage for hernias is much stronger than male lineage—children are more likely to have hernias if their mother had one than if their father did.