Epigastric Hernias develop in the upper mid-abdomen, usually along the line between the sternum and the belly button. Either a congenital weakness (meaning present since birth) or an acquired defect in the abdominal wall exists in this area allowing abdominal contents to protrude through creating a bulge. In addition to the deformity and an associated bulge, the signs and symptoms include pain at or near the area.
Epigastric Hernias can also occur at any time during later life. They often occur in adulthood because of progressive and significant tension on the area of weakness along the mid-line of the upper abdominal wall. This develops through the normal stresses and strains of daily activity.
Preparation for Epigastric Hernia Surgery
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 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.
Procedure for Epigastric Hernia Surgery
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.
Recovering from Epigastric Hernia 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 during the first 24 to 72 hours.
- 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, and working.
Epigastric Hernia Risk Factors
Any operation may be associated with complications. The primary complications of an Epigastric Hernia repair operation:
- Bleeding and infection
- 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 risk of your hernia repair is less than the risks of leaving the condition untreated.