Epigastric Hernia Repair (Adult)

Introduction

An epigastric hernia is a type of hernia that occurs in the epigastric region, which is the area between the navel and the lower part of the breastbone. It is a protrusion of the intestine or other abdominal tissue through a weakness or defect in the abdominal wall.

Causes and Risk Factors

Epigastric hernias are often caused by a combination of factors, including:

• Weakened abdominal muscles
• Increased pressure within the abdomen
• Genetic predisposition
• Aging
• Obesity
• Pregnancy
• Chronic coughing or straining
• Previous abdominal surgery

Symptoms

The symptoms of an epigastric hernia may include:

• A lump or bulge in the epigastric region
• Pain or discomfort in the epigastric region, which may worsen with coughing, straining, or heavy lifting
• Nausea and vomiting
• Constipation or difficulty passing stools
• Abdominal tenderness or guarding (muscle tension)

Diagnosis

The diagnosis of an epigastric hernia is typically made through a combination of:

• Physical examination, including palpation (feeling) of the abdomen
• Medical history, including questions about symptoms and risk factors
• Imaging studies, such as:
• X-rays
• Computed tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Ultrasound

Treatment Options

The treatment options for an epigastric hernia include:

• Watchful waiting, which involves monitoring the hernia for changes in size or symptoms
• Surgical repair, which may be performed using open or laparoscopic techniques
• Open repair: an incision is made in the abdomen to access and repair the hernia
• Laparoscopic repair: several small incisions are made in the abdomen, and a laparoscope (a thin, lighted tube with a camera) is used to visualize and repair the hernia

Surgical Repair Procedure

The surgical repair procedure for an epigastric hernia typically involves:

• Administration of general anesthesia or local anesthesia with sedation
• Making an incision in the abdomen, either open or laparoscopic
• Identifying and isolating the hernia sac
• Reducing the herniated tissue back into the abdominal cavity
• Repairing the defect in the abdominal wall using sutures or mesh
• Closing the incision(s)

Postoperative Care and Recovery

After surgical repair of an epigastric hernia, patients typically:

• Experience some pain and discomfort, which can be managed with medication
• Need to rest and avoid heavy lifting or strenuous activities for several weeks
• May need to follow a liquid diet or soft food diet for several days
• Should follow wound care instructions to promote healing and prevent infection
• Can typically return to normal activities within 4-6 weeks

Complications and Risks

The complications and risks associated with epigastric hernia repair include:

• Infection
• Bleeding or hematoma
• Adhesions or scar tissue formation
• Recurrence of the hernia
• Nerve damage or numbness
• Bowel obstruction or injury

Prevention

To help prevent epigastric hernias, individuals can:

• Maintain a healthy weight
• Avoid heavy lifting or straining
• Exercise regularly to strengthen abdominal muscles
• Avoid smoking and manage chronic coughing
• Eat a high-fiber diet to prevent constipation