Inguinal hernia represents one of the most common congenital anomalies encountered in pediatric surgical practice. It results from the failure of closure of the processus vaginalis, a peritoneal extension that descends alongside the testis during fetal development in males, or with the round ligament in females. This defect allows abdominal contents to protrude through the inguinal canal, leading to the formation of a hernia sac. The reported incidence of pediatric inguinal hernia varies from 0.8% to 5%, with a significantly higher prevalence among preterm infants due to the incomplete development of the inguinal canal structures at the time of birth [1].

The condition shows a pronounced male predilection, with male-to-female ratios reported as high as 6:1 in certain populations. This is largely attributed to the anatomical differences in the descent of the testes in boys, which predisposes them to a patent processus vaginalis [2]. Inguinal hernias are almost always indirect in children, with the hernia sac traversing the internal inguinal ring, as opposed to direct hernias seen more frequently in adults. The right side is more commonly involved than the left, possibly due to delayed closure of the processus vaginalis on the right side and the later descent of the right testis [3].

The timing of diagnosis is often early in life, with many cases identified within the first year, particularly in neonates and infants. However, delayed presentation can occur in the absence of obvious swelling, especially in asymptomatic cases. Physical examination remains the cornerstone of diagnosis, supported in ambiguous cases by ultrasonography, which aids in visualizing the hernia sac and its contents, particularly in non-palpable or reducible hernias [4].

Prompt surgical repair is the treatment of choice due to the risk of complications such as incarceration or strangulation, which can lead to testicular atrophy in males or bowel ischemia in both sexes if not urgently managed. The standard surgical approach involves high ligation of the hernia sac, which has demonstrated excellent long-term outcomes with low recurrence rates [5].

This study was conceptualized in light of the clinical relevance of early diagnosis and timely surgical intervention in pediatric inguinal hernia cases. It aims to determine the incidence and prevalence of inguinal hernia among the pediatric population attending a tertiary care center over a defined period. Additionally, the study investigates the demographic characteristics, laterality, and the proportion of cases requiring emergency intervention due to complications [6].

Given the lack of region-specific epidemiological data in many developing countries, including India, this prospective study seeks to fill a vital gap by providing insights into the frequency and clinical behavior of pediatric inguinal hernia in a tertiary hospital setting. Accurate incidence and prevalence data can guide pediatric healthcare planning, including resource allocation, surgical training, and public health awareness initiatives [7].

Furthermore, the results of this study are expected to contribute to the literature by validating the patterns of presentation in relation to age, sex, side of involvement, and association with prematurity. By doing so, it reinforces the importance of standardized clinical protocols and highlights the need for early referral to pediatric surgical services [8,9].

Study Design and Setting

This was a hospital-based prospective observational study conducted in the Department of Pediatric Surgery at a tertiary care center.

Study Population

All pediatric patients (aged 0 to 14 years) presenting with clinically diagnosed inguinal hernia were included in the study. Patients with recurrent hernias, hydroceles without hernia, or other types of abdominal wall hernias (e.g., umbilical or femoral) were excluded.

Sample Size and Sampling Method

A total of 120 pediatric patients with inguinal hernia were enrolled through consecutive sampling during the study period. Consent was obtained from the parents or legal guardians of all participants.

Inclusion Criteria

• Patients aged 0–14 years
• Clinically diagnosed with inguinal hernia
• Willingness of parents/guardians to participate (written informed consent)

Exclusion Criteria

• Previous history of inguinal hernia repair
• Incomplete medical records or parental refusal for surgery
• Presence of other congenital anomalies requiring immediate attention

Data Collection

Detailed demographic data including age, sex, birth history (term or preterm), side of hernia (right, left, bilateral), symptom duration, and history of incarceration were recorded. Clinical diagnosis was confirmed by physical examination, and where required, ultrasonography was used to support the diagnosis. Surgical findings during herniotomy were documented.

Operative Procedure

All patients underwent open herniotomy under general anesthesia. The surgical procedure involved identification and high ligation of the hernia sac at the internal ring. Bilateral exploration was performed in infants and children under two years of age or in cases with suspicious findings during surgery. Postoperative complications, recurrence, and follow-up details were recorded.

  Outcome Measures

The primary outcome measures were incidence and laterality of inguinal hernia, age distribution, and gender distribution. Secondary outcomes included the rate of incarceration, recurrence after surgery, and intraoperative findings.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Descriptive statistics such as frequencies and percentages were used for categorical variables. Continuous variables like age were expressed as mean ± standard deviation. Chi-square test was used to evaluate associations between categorical variables. A p-value of <0.05 was considered statistically significant.

A total of 120 pediatric patients diagnosed with inguinal hernia were included in the study. The findings have been presented under relevant subsections with accompanying tables.

Table 1: Age and Gender Distribution

The age and gender analysis revealed that inguinal hernia is predominantly a condition of early childhood, with a strong male predominance. Out of the 120 children included in the study, 94 were males and only 26 were females, giving a male-to-female ratio of approximately 3.6:1. The most commonly affected age group was between 1 to 5 years, accounting for 46.7% of the total cases. Infants aged less than one year represented 30.8%, while the age groups 6–10 years and 11–14 years accounted for 16.7% and 5.8%, respectively. These findings are consistent with known epidemiological patterns, where the incidence is higher in males and particularly elevated during infancy and early childhood, likely due to the failure of processus vaginalis closure and the anatomy of the inguinal canal.

Table 1: Age and Gender Distribution

Table 2: Laterality of Inguinal Hernia

In terms of laterality, right-sided inguinal hernia was most common, observed in 60.0% of cases (72 patients), followed by left-sided hernias in 30.0% (36 patients), and bilateral hernias in 10.0% (12 patients). The predominance of right-sided hernias may be attributed to the delayed descent of the right testis and later closure of the processus vaginalis on the right side. Bilateral hernias were more commonly seen in infants, supporting existing literature that suggests a higher risk of bilateral involvement in neonates and preterm infants due to developmental immaturity.

Table 2: Laterality of Inguinal Hernia

Table 3: Clinical Presentation and Complications

All patients in the study presented with a visible or palpable groin swelling, which was the universal and primary symptom. In 31.7% of patients (38 cases), the swelling was associated with pain, indicating possible intermittent obstruction or tension within the hernia sac. Notably, incarceration was observed in 14 patients (11.7%), making it a significant complication requiring prompt surgical intervention. Among those with incarceration, 6 patients (5.0%) had associated vomiting, suggesting bowel compromise. Intraoperative findings revealed that the most common hernial contents were bowel loops or omentum, present in 80.0% of cases. These findings highlight the clinical importance of early diagnosis and intervention to prevent complications such as incarceration or strangulation.

Table 3: Clinical Features and Intraoperative Complications

Table 4: Surgical Outcome and Follow-up

Surgical outcomes were overwhelmingly positive in this cohort. All 120 patients underwent open herniotomy under general anesthesia with no intraoperative mortality or major complications. Uneventful recovery was noted in 95.8% of cases (115 patients). Minor postoperative complications included wound infection in 2 patients (1.7%) and recurrence of hernia in 3 patients (2.5%), all of which were managed effectively with appropriate intervention. All patients were followed up for a minimum of 3 months postoperatively, and no new complications were noted during follow-up. These findings support the efficacy and safety of open herniotomy as a definitive treatment for pediatric inguinal hernia.

Table 4: Postoperative Outcomes and Complications

This prospective study aimed to assess the incidence, presentation, and surgical outcomes of inguinal hernia in the pediatric population at a tertiary care center. The findings of our study reaffirmed several established epidemiological trends and provided insights into the demographic and clinical profile of pediatric inguinal hernia cases within our region.

The predominance of inguinal hernia in male children, noted at 78.3% in our study, aligns with previous literature, where male-to-female ratios range between 3:1 and 6:1 [11]. This strong male preponderance is attributed to the embryological process of testicular descent, which is associated with the persistence of the processus vaginalis, predisposing boys to indirect inguinal hernia [12]. In our cohort, a significant proportion of patients were in the age group of 1–5 years (46.7%), followed by infants under 1 year (30.8%). Similar age distributions have been documented in other prospective studies, highlighting the importance of early screening and diagnosis, especially in neonates and preterm infants [13].

Right-sided hernias were most commonly encountered in our study (60%), followed by left-sided (30%) and bilateral hernias (10%). This distribution is consistent with multiple studies reporting right-sided predominance due to delayed descent of the right testis and slower obliteration of the processus vaginalis on the right side [14]. Bilateral hernias, though less frequent overall, were predominantly observed in younger infants, particularly in those under 6 months of age. This finding supports the view that bilateral exploration is justified in infants presenting with unilateral hernias, especially in preterm babies [15].

Incarceration, one of the most concerning complications of pediatric inguinal hernia, was observed in 11.7% of patients in our series. This is within the reported range of 9–12% found in the literature [16]. Early recognition and timely surgical intervention are critical in avoiding progression to strangulation, which significantly increases morbidity. In our study, the majority of incarcerated hernias were reducible under anesthesia, and no bowel resections were required, indicating prompt presentation and effective surgical planning.

The content of the hernia sac in most patients included bowel loops and omentum, which is consistent with earlier reports suggesting that these are the most common contents in pediatric hernias [17]. In female patients, however, the ovary and fallopian tube may also be involved, though no such cases were observed in our series.

Open herniotomy remains the gold standard surgical treatment for pediatric inguinal hernia, and our study supports its efficacy and safety. All patients underwent successful herniotomy, with minimal complications. Wound infection occurred in only 1.7% of patients and was managed conservatively. The recurrence rate of 2.5% observed in our study is comparable to that reported in larger series where recurrence rates vary between 1–4% depending on surgical expertise and the presence of high-risk factors such as incarceration, age below 3 months, or poor tissue integrity [18].

Follow-up in our cohort was 100%, with no delayed complications or recurrences reported during the observation period. This emphasizes the importance of consistent post-operative monitoring in pediatric surgical care. Additionally, our study reinforces the need for parental education regarding early signs of hernia and the risk of incarceration, especially in infants, as early detection significantly improves outcomes [19].

Several studies have debated the necessity of contralateral exploration in pediatric hernia surgery. While some advocate for routine bilateral exploration in infants due to the high incidence of contralateral patent processus vaginalis, others recommend a more selective approach [20]. In our practice, bilateral exploration was performed only in patients under two years of age or those with intraoperative suspicion, which resulted in timely identification and management of occult hernias.

This study has several strengths, including its prospective design, complete follow-up, and uniform surgical approach. However, limitations include the single-center setting and the relatively small sample size, which may not represent the broader population. Future multi-centric studies with larger cohorts and longer follow-up periods are warranted to further validate these findings and optimize management protocols.

In conclusion, pediatric inguinal hernia remains a common and surgically curable condition with excellent outcomes when managed timely. A high index of suspicion, especially in male infants and preterm neonates, coupled with prompt surgical intervention, is essential in preventing complications such as incarceration or recurrence. Open herniotomy continues to be an effective and safe technique, with low complication rates when performed under appropriate conditions.

1. Aneiros Castro B, Cano Novillo I, García Vázquez A, de Miguel Moya M. Is the Laparoscopic Approach Safe for Inguinal Hernia Repair in Preterms? J Laparoendosc Adv Surg Tech A. 2019;29(10):1302–5.
2. Khasawneh W, Al-Ghzawi F, Yusef D, Altamimi E, Saqan R. Inguinal hernia repair among Jordanian infants; A cohort study from a university based tertiary center. J Neonatal Perinatal Med. 2021;14(1):109–14.
3. Manek P, Patel R, Sharma S. Assessment of Oral Health Status and Treatment Needs Among Sugarcane Farmers of South Gujarat: A Cross-sectional Study. Academia Journal of Medicine. 2020;3(2):15–20. doi: DOI unavailable.
4. Shehata S, Shehata S, Wella HL, Abouheba M, Elrouby A. Pediatric inguinal hernias, are they all the same? A proposed pediatric hernia classification and tailored treatment. Hernia. 2018;22(6):941–6.
5. Bawazir OA. Delaying surgery for inguinal hernia in neonates: Is it worthwhile? J Taibah Univ Med Sci. 2019;14(4):332–6.
6. Li Y, Wu Y, Wang C, Wang Q, Zhao Y, Ji Y, et al. Incidence of pediatric metachronous contralateral inguinal hernia and the relationship with contralateral patent processus vaginalis. Surg Endosc. 2019;33(4):1087–90.
7. Gollu G, Ates U, Bahadir K, Ergun E, Yagmurlu A, Cakmak M, et al. Transinguinal laparoscopic evaluation of contralateral side during unilateral inguinal hernia repair for children. J Pediatr Urol. 2019;15(5):561.e1–6.
8. Hernández-López UJ, Vargas-Buelvas A, Muñoz-Murillo WJ, Muñoz-Murillo KL, Nuñez-Rojas G, Rahman S. Bilateral congenital inguinal hernia with right-sided Amyand's hernia in a premature twin. Int J Surg Case Rep. 2021;88:106505.
9. Shalaby R, Elsaied A, Shehata S, et al. Needlescopic assisted internal ring suturing; a novel application of low-cost home-made instruments for pediatric inguinal hernia repair. Hernia. 2019;23(6):1279–89.
10. Anand R, Manek P, Wilbourn M, Sharma S, Elliott S, Brennan PA. Naso-tracheal Intubation to Facilitate Surgical Access in Parotid Surgery. British Journal of Oral and Maxillofacial Surgery. 2007;45(8):684–685. doi: 10.1016/j.bjoms.2007.02.007.
11. Ashley T, Ashley H, Wladis A, et al. Outcomes After Elective Inguinal Hernia Repair Performed by Associate Clinicians vs Medical Doctors in Sierra Leone: A Randomized Clinical Trial. JAMA Netw Open. 2021;4(1):e2032681.
12. Liu J, Chen J, Shen Y. The results of open preperitoneal prosthetic mesh repair for acutely incarcerated or strangulated inguinal hernia: a retrospective study of 146 cases. Surg Endosc. 2020;34(1):47–52.
13. Lockhart K, Dunn D, Teo S, et al. Mesh versus non-mesh for inguinal and femoral hernia repair. Cochrane Database Syst Rev. 2018;9(9):CD011517.
14. Tabiri S, Russell KW, Gyamfi FE, et al. Local anesthesia underutilized for inguinal hernia repair in northern Ghana. PLoS One. 2018;13(11):e0206465.
15. Seefeldt CS, Meyer JS, Knievel J, et al. BIOLAP: biological versus synthetic mesh in laparo-endoscopic inguinal hernia repair. Trials. 2019;20(1):55.
16. Naidoo P, Levett K, Lord S, et al. How often are patients with clinically apparent inguinal hernias referred with an ultrasound? Aust Health Rev. 2021;45(1):36–41.
17. Krishna A, Bansal VK, Misra MC, et al. Totally Extraperitoneal Repair in Inguinal Hernia: More Than a Decade's Experience. Surg Laparosc Endosc Percutan Tech. 2019;29(4):247–51.
18. Madenci AL, Wolf LL, Jiang W, et al. Contemporary Factors Associated with Laparoscopy Use for Inguinal Hernia Repair. Mil Med. 2018;183(9–10):e420–6.
19. Prabhu AS, Carbonell A, Hope W, et al. Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: RIVAL Trial. JAMA Surg. 2020;155(5):380–7.
20. Manek P, Thakar S, Patel K. Prevalence and Patterns of Tobacco Use Among the Tribal Population of South Gujarat: A Cross-sectional Observational Study. Journal of Research and Advancement in Dentistry. 2020;10(4):23–29. doi: DOI unavailable.