Epigastric Hernia: what it is, causes, symptoms and repair surgery

• Epigastric hernia is one of the variants of abdominal hernia, located in the upper and central part of the abdomen.
• The most common symptoms of an epigastric hernia include bulging, caused by a kind of pouch or sac that protrudes outwards.
• The only way to completely eliminate an epigastric hernia is by surgical intervention, which can be done by hernioplasty or herniorrhaphy.

Epigastric hernia is a form of abdominal hernia. Abdominal hernias consist of a defect in the abdominal wall, which causes some tissue or organ (usually the intestine) to bulge outwards. The outflow of these elements causes the formation of a lump that can be seen and felt.

In this article we are going to talk about epigastric hernias, a type of abdominal hernia. Epigastric hernias are hernias located between the navel and the lower end of the sternum.

Aponeurotic fibres are a type of fibres found in the area of the abdomen above the umbilicus. These fibres are cross-linked, which makes them very strong and keeps the abdominal area strong.

In the case of a person suffering from an epigastric hernia, the cross-linking of the aponeurotic fibres is not uniform and the fibres are further apart. This increases the chances of a tear in the area.

It should be noted that the intertwining of fibres is congenital in origin, i.e. we are born with it. Therefore, if the abdominal wall is not well formed from birth, it will gradually weaken and consequently form an epigastric hernia.

Apart from the congenital cause that causes epigastric hernia, there are other causes that can produce it, such as the weakening of the abdominal wall due to other reasons such as:

• Lifting heavy weights
• Performing heavy physical exertion
• Pregnancy in the case of women
• Ageing
• Overweight

We could say that any activity that causes pressure on the abdomen may cause weakening of the tissue.

Weakening of the abdominal wall can also occur due to a previous surgical incision made in the abdominal area.

It should be noted that epigastric hernias occur three times more often in men than in women, and occur more often in young and middle-aged adults.

The main symptom of epigastric hernia is the hernia bulge in the area between the sternum and the navel. This bulge is also what allows the specialist to diagnose the hernia. When the patient makes any abdominal effort, the hernia may become more evident, increasing the size of the bulge.

Another of the symptoms of epigastric hernia may be:

Pain, which can be mild to moderate, becoming more intense with exercise, coughing, palpation of the hernia, etc. In this case, we could say that the pain caused by the epigastric hernia is associated with the effort made by the patient.

On the other hand, in many cases the epigastric hernia does not cause pain to the patient, but only the bulge is observed on exertion. Even if it does not cause pain, it should still be checked by a specialist to avoid further complications.

Constipation may be another symptom, due to obstruction of part of the bowel protruding into the hernia sac.

Incarceration and strangulation of an epigastric hernia

In some cases the epigastric hernia can become incarcerated or strangulated, i.e. it can become trapped or stuck in the hernial orifice and even cause a lack of blood supply to the area.

In these cases, the hernia causes severe pain to the patient and it is necessary to visit the specialist as soon as possible, as surgery is required to repair this problem. It is for this reason that it is necessary to repair the hernia surgically as soon as possible, as later there may be intraoperative complications or an emergency operation may be required.

Surgery, by which the defect in the abdominal wall is repaired, is the only way to repair an epigastric hernia. When you decide to have surgery to remove your epigastric hernia, you should be aware that there are two techniques that can completely solve the problem.

Hernioplasty

This is one of the most common techniques for removing epigastric hernias, as well as other abdominal hernias located elsewhere.

Hernioplasty involves the reintroduction of the hernia into the patient's abdominal cavity. After reintroduction, the surgeon will place a surgical mesh made of synthetic material in the wall of the abdominal cavity that was defective. This will keep the weakened area strong and prevent the hernia from recurring.

We could say that the surgical mesh mimics the cross-linked aponeurotic fibres that we have in the abdomen, which makes the area stronger again.

In most cases, hernioplasty lasts approximately 30 - 40 minutes.

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Laparoscopic hernioplasty

On the other hand, hernioplasty can also be performed using a laparoscopic approach, i.e. a minimally invasive technique that allows the patient to recover in less time.

A laparoscope is an instrument with a tiny camera at one end, which is connected by fibre optics to a monitor in the operating theatre, allowing the surgeon to see inside the patient's abdominal cavity. The laparoscope also has a light source at the end, which allows the surgeon to see inside the abdominal cavity.

Laparoscopic surgery generally lasts longer than open hernia repair surgery, approximately 90-120 minutes.

The laparoscopic technique basically consists of making 3 or 4 incisions in the area to be operated on, through which the specialist inserts the laparoscope and other surgical instruments to successfully repair the hernia.

After repairing it, the surgeon places a surgical mesh made of synthetic material in the damaged abdominal wall, which keeps the wall strong and prevents the hernia from recurring. Finally, the surgical incision is sutured.

Herniorrhaphy

Herniorrhaphy is another of the most commonly performed techniques to repair an abdominal hernia.

It consists of the reintroduction of the hernia into the patient's abdominal cavity, in the same way as hernioplasty. However, in this case, the patient does not have a surgical mesh placed in the defective area of the abdominal wall; instead, once the hernia has been reintroduced, the surgeon places stitches in the defective area of the abdominal wall.

Both hernioplasty and herniorrhaphy are recommended to repair an epigastric hernia, since the main objective is to repair it and prevent it from recurring.

However, there are a number of notable advantages of hernioplasty over herniorrhaphy, such as, for example, the pain it causes the patient in the postoperative period, which is less in the case of hernioplasty.

One of the advantages is the patient's recovery time, which is shorter in the case of performing a hernioplasty.

In terms of patient recovery time after epigastric hernia surgery, laparoscopic hernioplasty has an advantage, as patient recovery times are shorter because the surgical wounds are very small.

Finally, it should be noted that the patient's stay in hospital after the operation is, at most, 1 or 2 days.

If you would like to know more about the treatment of an epigastric hernia, click on Epigastric hernia surgery.

If you are considering epigastric hernia surgery and would like a pre-surgical assessment consultation with one of our general surgery specialists, you can request a consultation by contacting our patient service team via our contact form or by calling at +34 91 141 33 56, or by clicking on the request an appointment button below: