Epigastric Hernia Repair
WHAT IS AN EPIGASTRIC HERNIA?
- A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery.
- An epigastric hernia comes through the linea alba between the umbilicus and the bottom end of the sternal bone.
- These hernias are multiple in 20% of the cases.
- The defects in epigastric hernias are usually very small and the hernias contain prepeitoneal fat with no peritoneal sac. Occasionally one of these hernias if left untreated can become large and develop a peritoneal sac with abdominal contents contained within the hernia.
- Both men and women can get an epigastric hernia but men are 2 to3 times more likely to develop this type of hernia.
- A hernia does not get better over time, nor will it go away by itself.
- Complications of epigastric hernias such as incarceration and strangulation do occur but at a very low rate. Obstruction is extremely uncommon.
HOW DO I KNOW IF I HAVE AN EPIGASTRIC HERNIA?
- Epigastric hernias occur in the upper abdomen usually just off the midline.
- It is usually easy to recognize an epigastric hernia. You may notice a bulge under the skin in the upper abdomen. You may feel pain when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting.
- The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day.
- Severe, continuous pain, redness, and tenderness are signs that the epigastric hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon.
WHAT CAUSES EPIGASTRIC HERNIAS?
The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop an epigastric hernia at any age. A natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate. In the epigastric region, there is a natural weakness as the linea alba contains no muscle and only a single layer of fascia. Furthermore, as we age the linea alba widens and becomes thinner.
WHAT PREPARATION IS REQUIRED?
- Most epigastric hernia operations are performed on an outpatient basis, and therefore you will probably go home on the same day that the operation is performed.
- Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
- After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
- It is recommended that you shower the night before or morning of the operation.
- If you have difficulties moving your bowels, an enema or similar preparation may be used after consulting with your surgeon.
- After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
- Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
- Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
- Quit smoking and arrange for any help you may need at home.
HOW IS THE PROCEDURE PERFORMED?
There are few options available for a patient who has an epigastric hernia. Most epigastric hernias require a surgical procedure at some point in time. The open approach is done from the outside through an incision over the palpable mass. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The defect is usually small and can often be closed with sutures. This technique is usually done under local anesthesia with sedation. The laparoscopic approach cannot be used for small epigastric hernias because there is no visible peritoneal sac from inside the abdomen. This approach can be used in large epigastric hernias with a peritoneal sac. It requires several small incisions away from the epigastrium for the operative trocars. A piece of mesh is placed within the abdomen through one of the trocar sites and is held in place with sutures through the muscle layers and surgical tacks around the edges of the mesh.
WHAT SHOULD I EXPECT AFTER SURGERY?
- Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
- Once you are awake and able to walk, you will be sent home.
- With any hernia operation, you can expect some soreness mostly during the first 24 to 72 hours.
- Most often the postoperative pain, if done laparoscopically, is not at the previous hernia site but around the edges of the mesh where the sutures have been placed through the muscle to fix the mesh in place.
- You are encouraged to be up and about the day after surgery.
- You will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, light lifting, working and engaging in sexual intercourse.
- Call and schedule a follow-up appointment within 2 weeks after you operation.
WHAT COMPLICATIONS CAN OCCUR?
- Any operation may be associated with complications. The primary complications of any operation are bleeding and infection but these are uncommon with umbilical hernia repair.
- There is a slight risk of injury to the intestines, blood vessels and nerves.
- Difficulty urinating after surgery is not unusual and may rarely require a temporary tube into the urinary bladder for as long as one week.
- Any time an epigastric hernia is repaired it can come back or a new hernia can occur adjacent to the previous repair. The long-term recurrence rate is after epigastric hernia repair is reported as high as 10%. Your surgeon will help you decide if the risks of umbilical hernia repair are less than the risks of leaving the condition untreated.
- When the surgery has been done laparoscopically, it is common for fluid to collect in the old hernia sac. This is called a seroma and usually resolves over time.
WHEN TO CALL YOUR DOCTOR
Be sure to call your physician or surgeon if you develop any of the following:
- Persistent fever over 101 degrees F (39 C)
- Increasing abdominal or groin swelling
- Pain that is not relieved by your medications
- Persistent nausea or vomiting
- Inability to urinate
- Persistent cough or shortness of breath
- Purulent drainage (pus) from any incision
- Redness surrounding any of your incisions that is worsening or getting bigger
- You are unable to eat or drink liquids