Epigastric Hernia

A hernia occurs when an organ or intestine protrudes through a weak spot in the abdominal muscle. Hernias are classified based on where they form and what causes them.

A hernia in the epigastric region of the abdominal wall is called an epigastric hernia. This is located just below the sternum of your rib cage, above your belly button. Below, we take a detailed look at what epigastric hernia is, its causes, and the potential treatment options that you can try. 

What Is Epigastric Hernia  

Epigastrium means 'located over the stomach' and refers to the area of the anterior abdominal wall between the navel and the breastbone. The epigastric hernia occurs in the upper part of the abdominal wall as a lump or bulge due to a gap in the muscle. As a result of this gap in the abdominal wall, parts of the pre-peritoneal fatty tissue can slip through, forming a hernia sac.

In most cases, the abdominal wall pinches the fat, causing pain.

This type of hernia can be congenital but generally tend to develop only later in life.

It is possible for epigastric hernias to develop at birth. A person may have more than one epigastric hernia at once, and their sizes can vary. In most cases, epigastric hernias are small, only breaking through the surrounding tissues. A large hernia may, however, allow fat tissue or part of the stomach to pass through.

It is common for people with small hernias to not feel any pain and notice them only at certain times. However, if the hernia size is large, then you are likely to feel pain and discomfort, which should be immediately treated.

What Causes Epigastric Hernia

In the epigastric region, where the abdominal wall joins the diaphragm, tension may cause an epigastric hernia. However, since this type of hernia is rarely reported, there is not much known about the exact causes behind it. 

Several factors can contribute to epigastric hernias, including:

• obesity
• pregnancy
• heavy lifting and other intense physical activities
• severe coughing

Symptoms 

It is common for people suffering from epigastric hernias not to experience any symptoms at all. It is possible for a child or adolescent to be unaware they have an epigastric hernia during their childhood and adolescence. 

It is important to note that the symptoms caused by hernias can vary considerably based on the size of the hernial orifice and the swelling of the hernia. For instance, if the hernia sack has abdominal fluid in it, it can lead to swelling, which may not happen in other cases of epigastric hernias.

Pain, tenderness, and discomfort just above the belly button and the breastbone are other common symptoms that can occur in most cases of epigastric hernias.

Diagnosis

Hernias in the epigastric region are rarely painful. It is often easier to see them when you are standing. 

Your doctor will conduct a physical examination to diagnose an epigastric hernia. During the exam, the doctor will ask about your medical history, your family history, and your symptoms. You may be asked to sit, lie, or stand in various positions by the doctor as he presses on your abdomen.

The healthcare professional may also use certain imaging techniques like ultrasound and CT scan to ensure there are no complications related to the hernia. 

Treatment Options for Epigastric Hernia

Surgery is recommended for people who have epigastric hernias since they don't heal on their own.

Generally, general anesthesia is used for this kind of operation, and the operation lasts around 30 minutes. The surgery involves making an incision near the hernia location and pushing the hernia sac back into its place. In the case of only fat pushing through, your surgeon will either remove it or push it back. When your abdomen's contents are also pushing through, the surgeon will place them back inside.

The abdominal wall defect will be strengthened using synthetic mesh or dissolvable stitches to prevent the hernia from occurring again. 

Epigastric Repair Surgery: What to Expect

Before the surgery, you will be asked to take some tests, including a blood test and chest X-ray. In some cases, you may need to be hospitalized the day before surgery, the night after surgery, or even both days, depending on your medical condition. Most of the time, though, you'll go home the evening after surgery.

The surgery can be either an open hernia repair surgery or a laparoscopic hernia repair. If it is an open repair surgery, then the surgeon will make incisions around the defective area and perform the repair. If you are going for laparoscopic surgery, then the doctor will insert a laparoscope, which is a small camera in the body through the incisions. The camera will display the internal body images on a monitor screen, which will assist the doctor in performing the repair. 

Laparoscopic repair is a minimally invasive procedure and offers a quicker recovery time. Both surgeries commonly use dissolvable stitches to close the incisions. The wound will then be covered with a waterproof dressing by the surgeon.

With some minor restrictions, you might even be able to return to school or work within a few days. It is generally recommended that you do not lift any weight over a gallon of milk for six to eight weeks following your surgery.

Depending on your doctor's advice, you may be able to resume your normal activities within a short time frame. In most cases, it takes the patients around 4-6 weeks to get to their normal routine work.