The pediatric inguinal hernia.

(1) Think "little" when approaching the pediatric hernia. (2) The landmarks, incision, and operative technique are different from the approach in adults. (3) Do not operate unnecessarily. Delay correction of noncommunicating hydroceles in neonates for 3 to 4 months, and do not routinely explore the contralateral side unless there is suspicion of hernia. (4) For the usual hernia with minimal damage to the floor of the canal, high ligation of the sac and anatomic closure is all that is necessary. (5) For moderate enlargement of the internal ring and consequent weakening of the floor, imbrication techniques to reinforce the floor as well as high ligation of the sac will suffice. (6) Finally, with very large hernias and complete destruction of the floor of the inguinal canal, a major procedure such as the McVay herniorrhaphy will be necessary.