Epigastric Hernia
What is an Epigastric Hernia?
An epigastric hernia is a type of abdominal hernia where abdominal contents protrude through a weakness at the midline of the abdomen, along the anatomical linea alba. This structure is a tendon that runs from the end of the sternum, i.e., the xiphoid process, to the pelvis and serves as an attachment point for the abdominal muscles. This is a fairly common disease, affecting up to 10% of middle-aged adults, and is three times more common with women. An epigastric hernia should not be confused with diastasis recti, which is a tear in the abdominal rectus muscles as wide as 2.5cm. A hernia on the other hand refers to the protrusion of an organ through a defect. Diastasis recti is due to damage from injury or increased intraabdominal pressure but can progress to become an epigastric hernia if left untreated.
Epigastric Hernia – Causes
The main causes of an epigastric hernia are weakening or damage to the abdominal wall, i.e., rectus muscles, resulting in a pathological movement of abdominal contents as a hernial sac underneath the skin. Additional risk factors include:
- Congenital defects in the abdominal wall in children with signs appearing around preschool age
- Weakness of the transverse fascia layer
- Obesity
- Chronic obstructive pulmonary disease, especially when accompanied by a chronic cough
- Chronic constipation
- Lifting heavy objects
- Intense physical exercise
- Pregnancy, due to increased abdominal circumference applying pressure on the rectus muscles
- Disorders in collagen metabolism
- Benign prostatic hyperplasia, or other conditions of the prostate causing frequent urination
Epigastric Hernia – Symptoms
Early epigastric hernias may be asymptomatic. Over time, however, a small bulge forms under the skin that grows when the pressure inside the abdomen increases, such as during vigorous exercise, coughing, or lifting heavy objects. Additionally, people with epigastric hernias may experience mild pain and discomfort around the navel region along with a pulling sensation when leaning forward.
Epigastric Hernia – Diagnosis
Epigastric hernias are diagnosed by careful palpation, during which a physician looks for a characteristic subcutaneous bulge or thickening around the navel region. Sometimes, an abdominal ultrasound is indicated to confirm the diagnosis. Incarceration refers to the failure of the hernial sac to spontaneously return to the abdominal cavity. This may compromise blood flow to the hernial sac through a process called strangulation, a potentially fatal complication. Because epigastric hernias do not spontaneously resolve, surgical correction is necessary to avoid the risk of incarceration and strangulation.
Epigastric Hernia – Treatment
The size and severity of an epigastric hernia will determine the type of surgery and anesthesia used, i.e., local or general. Surgical repair can be classic (open) or using minimally invasive techniques such as laparoscopic or robotic surgery. In the case of small epigastric hernias, a surgeon typically only has to suture closed the defect in the tissue. However, in cases of larger epigastric hernias, it becomes necessary to repair and reinforce the defect from inside the abdominal cavity. This is done by suturing a special medical mesh over the hernia opening to strengthen the abdominal rectus muscles and prevent a recurrence. Minimally invasive techniques allow for better visualization of the surgical field, which results in greater precision and lower risk of unintentional nerve, blood vessel, and tissue damage. Minimally invasive surgery offers patients several key advantages over classic, open techniques. Namely, there is less intraoperative blood loss and a lower risk of surgical site infection. The postoperative recovery period is also shorter and less painful, allowing patients to return to their daily routines sooner. Finally, scars are often barely visible when healed, achieving a vastly superior cosmetic effect for patients as compared with classic, open surgery.
Epigastric Hernia – Recovery
Hospitalization after epigastric hernia repair depends on the extent of the procedure and the method used. However, one can expect to remain hospitalized for about 1-3 days. The recovery period ranges from 4 to 6 weeks, patients must avoid lifting heavy objects or intense physical exertion for that duration.
Epigastric Hernia – Price
The price of an epigastric hernia repair depends on the type of hernia, its location, the type of mesh used to reinforce the abdominal wall, the type of anesthesia used (local or general), and whether it is done classically, laparoscopically, or robotically. All details of the operation and possible treatment options are always discussed together with the attending physician during the initial consultation where you are qualified for the procedure.
