Epigastric hernias

Epigastric hernia is when fat or part of the intestines pushes through a weakness in the wall of your abdominal muscles between the belly button (umbilicus) and the chest. Epigastric hernias may also be called ventral hernias by your doctor. About 75% of epigastric hernias happen in males. Epigastric hernia is usually small. It is possible to have more than one at the same time. Some seem to appear and disappear, which is known as a reducible hernia.

Many epigastric hernias are small, cause no symptoms, and don’t need treatment. Larger epigastric hernias that do cause symptoms won’t heal on their own, but surgery can fix the problem. Surgery can help to relieve pain that is caused by the epigastric hernia. Many patients wish to have a hernia repaired because they are increasing in size, becoming more unsightly and uncomfortable.

If you have an epigastric hernia, talk to your doctor about your treatment options. Your doctor can tell you whether this hernia should be left alone or whether surgical repair is needed.

What would happen if epigastric hernia was not treated?

The weakness in the muscle wall could enlarge and rarely may contain loops of the bowel. In these circumstances if you are unable to push the hernia back, a blockage of the bowel may occur, which causes vomiting and abdominal pain. If you experience this you should contact your doctor immediately as you may require an emergency operation.

An incarcerated hernia can become dangerous if strangulation occurs. This happens when the blood supply is cut off from the tissue or organ parts that are trapped inside the incarceration. Because cell death becomes likely, a strangulated hernia is considered an emergency.

Are there any alternatives to surgery?

Epigastric hernia can be left alone but pain caused by the hernia will usually continue and complications can happen. Epigastric hernia will not get better without surgery.

Epigastric hernia causes

A hernia is when part of the intestine bulges through the muscle wall that’s supposed to hold it in place. Some epigastric hernias are present at birth. With an epigastric hernia, the opening is near the center of the abdomen (belly), between the bottom of the breastbone (sternum) and the belly button. This area is called the epigastrium.

Epigastric hernias happen because of problems where the abdominal muscles on both sides come together. This lets fatty tissue push through the muscles, causing pain and a small lump.

Babies can be born with this problem, or it can happen later because of weakness in the surrounding muscles or strain on the abdominal wall. Obesity, straining, coughing, heavy work, sports, and pregnancy both put pressure on the abdominal wall and can be risk factors for epigastric hernias.

Epigastric hernia symptoms

Most epigastric hernias don’t cause symptoms. Epigastric hernias are often not noticed until an imaging test is performed for another purpose. When epigastric hernias cause symptoms, a child might have:

• A small bump or swelling above the belly button. In infants with epigastric hernias, they may be more apparent when the baby is crying or having a bowel movement.
• Discomfort or pain. The pain may get worse when the child stands, sneezes, coughs, or strains to go to the bathroom.

While epigastric hernias can cause pain, they often are not felt at all.

Because epigastric hernias are often asymptomatic, it is not uncommon for an adult to be diagnosed with one that was developed before birth.

Epigastric hernia diagnosis

Doctors can diagnose an epigastric hernia by doing an exam to look for a bump and asking about a child’s symptoms, such as pain.

Small epigastric hernias are often diagnosed during a CT scan or another imaging test performed for a different reason. Epigastric hernias may never cause any symptoms.

If an epigastric hernia is causing symptoms, it may be diagnosed through a physical exam or through imaging tests such as ultrasounds.

Epigastric hernia treatment

Epigastric hernias don’t go away without treatment. So doctors may repair them with surgery if a hernia causes symptoms. The surgery usually takes about 30 minutes.

If epigastric hernia is small and is not causing any notable symptoms, it may be left unrepaired. Your doctor may wish to monitor it to see if it gets larger or causes any issues.

If an epigastric hernia frequently protrudes, it may be repaired for cosmetic reasons.

When tissue gets stuck in a hernia, this is known as an incarceration. Often, this tissue can be pushed back inside when the patient is lying on their back.

In infants who have epigastric hernias, repairs are often put off for several months. This is because babies are better able to tolerate anesthetic once they are older, which reduces any risks associated with surgery. As long as the hernia is not getting larger, the chances of complications are small.

Epigastric hernia surgery

To operate, your surgeon will:

• Give anesthesia so the child sleeps through the procedure and won’t feel any pain, but various anesthetic techniques are possible.
• Make a small incision (cut) in the skin over the hernia and free up the ‘hernial sac’.
• If only fat is pushing through, your surgeon will either remove the fat or push it back. If contents of your abdomen are also pushing through, they will place the contents back inside your abdomen.
• Your surgeon will remove the hernial sac and close the weak spot with strong stitches or a synthetic mesh.
• Close the hole or weak spot in the muscle with stitches.
• Close the incision with absorbable sutures under the skin and tape strips. The strips will fall off on their own in 1–2 weeks.

Most children can go home a few hours after the surgery. Things to know:

• Your child should have a sponge bath for the next week rather than a tub bath or shower.
• Your child may have some swelling and bruising near the surgery area. Apply cool compresses (a cloth dipped in cold water, a freezer pack, or a bag of ice) to the area to reduce swelling. Wrap it in a towel to protect the skin.
• Kids can eat normally and go back to their usual activities as soon as they feel up to it, usually in a few days. They should avoid sports and gym for a few weeks.
• Some kids get constipated (have trouble pooping) after surgery. Offer plenty of liquids, such as water and prune, pear, and apple juice. Serve high-fiber fruits and vegetables, such as pears, strawberries, and sweet potatoes. Avoid cheese, bananas, and white rice.
• Your child should not climb, play sports, or lift objects heavier than 10 pounds (about the weight of a gallon of milk) until the surgeon says it’s okay.
• Give any prescribed medicine or over-the-counter pain medicine exactly as directed.

Surgery complications

Some complications can be serious and can even cause death.

General complications of any operation include:

• pain
• bleeding
• infection of the surgical site (wound) – minor wound infections do not need any specific treatment. Antibiotics are given during the operation to minimize the risk of deep-seated infection.
• unsightly scarring of your skin
• blood clot in your leg
• blood clot in your lung

Specific complications of epigastric hernia repair:

• Developing a collection of blood (hematoma) or fluid (seroma) under your wound
  • wound hematoma – bleeding under the skin can produce a firm swelling like a bruise. This may simply dissipate gradually or leak out through the wound. If there is a lot of fluid this may occasionally result in you having to return to operating room in order for it to be dealt with.
• Injury to structures within your abdomen
• Recurrence – fortunately recurrence after hernia surgery should be rare (1-5%).

Recovery time

You should be able to go home the same day. You should be able to return to work after 1 to 2 weeks, depending on how much surgery you need and your type of work.

Do not lift anything heavy for at least 6 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask your doctor for advice.

Most people make a full recovery and can return to normal activities. Epigastric hernia can come back many years later and you may need another operation.