What's to know about epigastric hernia?
The majority of hernias occur in the abdomen, and there are several types of abdominal hernias, including those known as epigastric hernias.
What is an epigastric hernia?
An epigastric hernia may cause pain and tenderness.
Epigastric hernias are lumps or bulges that occur in the upper part of the abdominal wall - in an area known as the epigastrium, which is above the navel and just below the breastbone.
Epigastric hernias can be present from birth. They may vary in size, and it is possible to have more than one epigastric hernia at a time.
Typically, an epigastric hernia is small, with only the lining of the abdomen breaking through the surrounding tissue. Larger hernias, however, may cause fatty tissue or part of the stomach to push through.
For many people, small hernias do not cause problems, may only appear at certain times, and may not be noticeable when lying down. Many people are unaware that they have an epigastric hernia.
Causes and risk factors
An epigastric hernia is usually present from birth. It forms as the result of a weakness in the abdominal wall muscles or incomplete closure of abdominal tissue during development.
Some factors that may cause or exacerbate epigastric hernias include:
- coughing fits
- heavy lifting
- physical labor
- intensive training or sports
A visible abdominal bump may be a symptom of an epigastric hernia.
Image credit: PacoPeramo, 2014
People with epigastric hernias often do not experience any symptoms. Some people go through childhood and adolescence unaware they have an epigastric hernia. However, many children experience symptoms from a young age.
Symptoms in both adults and children include:
- an abdominal bump that can be seen and felt
Certain actions, such as straining, crying, or having a bowel movement, may produce or exacerbate these symptoms.
The symptoms of some epigastric hernias come and go, which is known as a reducible hernia.
Epigastric hernias are diagnosed based on a physical examination. The doctor will take a medical history, family history, and list of symptoms. They will press on the abdomen and may request the person to sit, lie, or stand in various positions.
A doctor may diagnose an epigastric hernia as an incarcerated hernia, which means it is stuck in the "out" position. Although not an emergency, this does require medical attention.
If a hernia does not have an adequate blood supply, it will require emergency treatment to prevent tissue damage. This is called a strangulated hernia.
Surgery: What to expect
Epigastric hernias do not heal by themselves, and people with an epigastric hernia are advised to consider surgery.
Repairing the hernia will alleviate symptoms and reduce the risk of complications, such as tissue damage or an enlarged hernia.
A pre-admission assessment will take place before the surgery. Tests include:
- blood tests
- a cardiogram
- a chest X-ray
To reduce any risk factors, the doctor may ask a person to lose excess weight or quit smoking before surgery.
Epigastric hernia surgery may be carried out on either an inpatient or outpatient basis.
If there are medical reasons for doing so, an individual may be admitted the day before surgery or may be required to stay in the hospital the night after surgery, or both. In most cases, however, a person will be admitted on the day of surgery and be allowed to go home that evening.
Surgical repair can be carried out under general anesthetic or local anesthetic, depending on the preference of the individual and the advice of the surgeon.
Once the anesthetic has taken its course, the surgeon will make an incision in the hernia and insert a laparoscope. This device is a thin tube with a light that allows the surgeon to look at the abdominal organs and hernia. The surgeon will then make another incision for surgical instruments.
The surgeon will move the hernia sac (the part of the tissue pushing out) to its correct position. They will also strengthen the muscle of the abdominal wall.
If the area causing muscular weakness is small, the surgeon may stitch it up. These permanent stitches are known as sutures, and they will prevent the hernia from pushing through again.
Large areas of muscular weakness may require a patch of nylon mesh, which is stitched in place to cover the hole. However, this may not be suitable for those who have previously rejected other surgical implants.
Once the hernia sac is in the correct position and the suture or mesh is in place, the surgeon will remove the laparoscope and close the surgical incision.
Dissolvable stitches are commonly used to close the wound. The surgeon will then cover the wound with a waterproof dressing.
Drinking fluids and staying hydrated immediately after surgery is recommended.
Some postoperative pain, discomfort, swelling, and bruising in the abdominal area are normal. Doctors may recommend pain relief for the first 48 hours.
A bulge may still be present after the surgery. This is likely to be caused by the suture used to close the abdominal wall and should diminish over time.
Following surgery, people should begin drinking fluids as soon as they can. If they can tolerate fluids, they may be able to commence a light diet.
As constipation and subsequent straining can cause postoperative problems, it is important to eat enough fiber and stay hydrated.
A doctor will recommend removing the dressing when the wound is sufficiently sealed, usually within 5 to 10 days. At this time, people can take a bath or shower.
Although people should not apply any pressure on the wound for at least 28 days, they should engage in light activity, which they can increase progressively over time.
Sexual activity can be resumed once it is comfortable to do so. People should avoid driving for at least 7 days.
A person must take great care when:
- moving from one position to another (for example, from lying down to sitting up)
- passing a bowel movement
Most people will be able to return to work within 2 to 4 weeks following surgery. However, people with jobs that require heavy lifting or intense activities should discuss this with their doctor.
People should seek immediate medical attention if they experience any of the following:
- persistent bleeding
- increased levels of pain, redness, or swelling around the wound
- discharge from the wound
Treatment for children
Children usually undergo the same operation as adults.
It may be advisable to delay surgery for newborns with an epigastric hernia until they are older and more able to tolerate surgery. This may not be possible in emergency cases.
Particular care is taken to prepare children for epigastric hernia surgery, and a pediatric surgeon usually performs the procedure.
Most people recover easily following surgery for an epigastric hernia. While there is a risk of recurrence, it tends to be low, with some estimates placing it between 1 and 5 percent.
Some research has found pregnancy may increase the risk of recurrence. A 2016 study suggests that mesh repair may raise the possibility of recurrence in women with a subsequent pregnancy.