Scottie Emmert

INT 3041: Experiential Learning in the Health Professions

Dr. Richard A. Falcone Jr.
Pre-Health Pediatric Surgery Internship
Pediatric Hernias: A Students Dissection of the Most Prevalent Surgical Problem of Childhood
Throughout the past semester, I have observed a multitude of pediatric surgical
procedures performed by the world-class surgeons at Cincinnati Childrens Hospital Medical
Center (CCHMC). From abdominal adhesions and ganglion cysts to chest ports and
circumcisions, shadowing Dr. Falcone at both the Main Campus and Liberty Campus of
CCHMC has exposed me to facets of surgery and the operating room that I never knew existed
discoveries that have only cemented my passion to pursue this exhilarating field of medicine in
the future. Despite these rewardingly unfamiliar shadowing experiences, a common theme of my
time observing pediatric surgery is the ubiquity of one condition that affects patients ranging
from less than 6 months old to nearly 60 years old: hernias.
Hernias, visible as a soft bulge underneath the skin, result when a portion of an organ
within the abdomen (e.g., intestines) protrudes through a weakness in the muscles of the
abdomen.1 When this abnormal bulge occurs at the umbilicus (belly button), the condition is
deemed an umbilical hernia; when it occurs in the groin (inguinal) area, the condition is deemed
an inguinal hernia. Umbilical hernias, which result from the inability of the abdominal muscles to
close the small opening that allows the umbilical cord to pass through, occur in 10%-20% of all
children and are particularly common in premature babies.2 Similiarly, inguinal hernias result
from the failure of a small sac, known as the processus vaginalis, that is normally open during
1 Cincinnati Childrens Hospital Medical Center. (April 2016). Inguinal hernia. Retrieved from
https://www.cincinnatichildrens.org/health/i/inguinal-hernia
2 Cincinnati Childrens Hospital Medical Center. (April 2016). Umbilical hernia. Retrieved from
https://www.cincinnatichildrens.org/health/u/umbilical-hernia

fetal life to fully close around the time of birth.3 Although these hernias, 80%-90% of which are
found in boys, are primarily found on the right side, they can occur on both sides in about 10%
of cases.4 These types of hernias often pop out when a child cries or strains. While umbilical
hernias may spontaneously close by ages 3 to 4, inguinal hernias never go away without
treatment.5
To prevent incarceration or strangulation of nearby organs in the hernia sac, pediatric
surgeons like Dr. Falcone can repair the hernia in minimally invasive operations similar to the
ones I have observed over the course of the semester. Depending on the clinical situation, the
surgical approach for repair of an inguinal hernia can be an open repair, laparoscopic repair, or
blend of the two. For example, open repair of an inguinal hernia is carried out under general
anesthesia and requires only 2 or 3 tiny incisions to close the opening to the hernia sac. After
making a small incision in the groin, the surgeon identifies and repairs the hernia sac, closes the
incision with dissolving stitches, numbs the incision site with local anesthetic, and seals the
surface of the incision with tissue glue and small bandages.6 However, the most spectacular
aspect of hernia repairs is that patients can go home the same day and return to normal activities
without restrictions in only a few days following this life changing operation.
Over the past fifteen weeks, I have shadowed a total of seven hernia repairs across both
umbilical hernia and inguinal hernia operations. Yet, I am still as fascinated by the procedure as I
was the very first time I observed Dr. Falcone perform it. In discussing the vast medical
knowledge demanded of a pediatric surgeon in hernia repair operations, Dr. Falcone described
3 UCSF Pediatric Surgery. (2016). Inguinal hernia. Retrieved from
http://pedsurg.ucsf.edu/conditions--procedures/inguinal-hernia.aspx
4 See supra note 1.
5 See supra note 2.
6 Childrens Hospital of Philadelphia. (2013). Inguinal hernia. Retrieved from
http://www.chop.edu/conditions-diseases/inguinal-hernia

this intellectual and technical challenge like that posed by riding a bikea seemingly difficult
task that becomes easier with experience. Beyond this intellectual and technical aptitude, Dr.
Falcone demonstrates an unparalleled bedside manner towards his patients and their families that
I hope to emulate in my own medical career. Such kindness impacted me personally early in my
pre-health internship experience, as Dr. Falcone happily and thoroughly answered my questions
about my fathers own inguinal hernia repair procedure at the beginning of the semester.
In conclusion, my pre-health pediatric surgery shadowing internship has confirmed my
desire to pursue surgery in an academic pediatric medical center like CCHMC. Thank you to Dr.
Falcone, his colleagues, and the faculty and staff of Trauma Services and the Comprehensive
Childrens Injury Center (CCIC) for providing me with one of the most rewarding learning
experiences of my entire life.