Non-inguinal hernias

Abstract Indirect inguinal hernias, hydroceles, and umbilical hernias are all common in infancy and childhood, whereas femoral, direct inguinal, epigastric, lumbar, incisional, and Spigelian hernias are less frequently encountered. The position and mode of presentation depend on the type. However, in capable hands, the specific clinical diagnosis is usually evident. For example, umbilical and supraumbilical hernias are in the midline, related to the umbilical ring, and are typically soft and easily reduced. Epigastric hernias are less common, typically presenting in young children. Femoral hernias are rare and may present diagnostic challenges. Where the diagnosis is less certain, ultrasound examination or cross-sectional imaging may be employed. Magnetic resonance imaging and computed tomography may be particularly useful in diagnosing abdominal wall hernias in obese children in whom physical examination is difficult. The majority of these hernias are dealt with by traditional open surgery. However, a small number of cases, such as the femoral hernias, may benefit from minimal-access diagnosis and surgery. In experienced hands, the outcomes are excellent in the vast majority of children who present with these hernias. However, complications of delayed intervention may include incarceration and bowel obstruction. Surgical complications include infection, wound breakdown, and poor cosmetic outcomes.