Congenital Inguinal Hernia: Presentation, Repair, and Bilateral vs. Inguinal Distinction

Congenital inguinal hernia results from patent processus vaginalis (PPV) — failure of peritoneal evagination closure by 40 weeks gestation.

Epidemiology

• Incidence: 1–5% full-term; up to 30% preterm.
• Male:Female = 6:1 (testicular descent).
• Right > Left (later testicular descent); Bilateral 10–15%.

Presentation

• Intermittent bulge in groin/scrotum (boys) or labia (girls) — increases with crying/straining.
• Reducible spontaneously or manually.
• Incarceration: Tender, irreducible, vomiting, distension — surgical emergency.
• Strangulation: Ischemic bowel — necrosis, perforation, sepsis.

Repair

• Open (herniotomy): Inguinal incision, high ligation of sac. Gold standard for infants.
• Laparoscopic: Transabdominal (TAPP) or extraperitoneal (TEP); bilateral simultaneous, diagnostic for contralateral PPV.
• Timing: Elective within weeks of diagnosis; urgent if incarcerated.

Bilateral vs. Inguinal Terminology

• Inguinal hernia: Location (inguinal canal). Can be unilateral or bilateral.
• Bilateral hernia: Inguinal hernias on both sides simultaneously.
• All congenital hernias in infants are inguinal (indirect). Direct hernias are acquired (adults).

Key Point

Bilateral is a laterality descriptor; inguinal is an anatomic descriptor. A bilateral hernia IS an inguinal hernia (on both sides).