Epigastric Hernia Surgery by a World-Renowned General Surgeon

An epigastric hernia occurs when tissue pushes through the inner layers of the abdominal wall, causing a bulge or tear. The hernias can be present at birth (congenital) or acquired. The bulge is usually positioned between the belly button and the chest.

With most epigastric hernias, both organ tissue and fatty tissue push through the abdominal muscle wall. In minor cases, epigastric hernias don't cause symptoms. Many go undiagnosed and are only discovered during testing for entirely different medical issues. In severe cases, the hernias can cause life-threatening complications.

The recommended treatment for an epigastric hernia is laparoscopic surgery.

What are the Symptoms of an Epigastric Hernia?

Epigastric hernias seem to come and go at will. This tendency to appear and disappear gives epigastric hernias their nickname: Reducible hernia. The bulge may not be noticeable unless you are having a bowel movement, crying, or engaging in an activity that puts pressure on the abdomen.

A physical exam can usually diagnose an epigastric hernia, while others require advanced imaging technology.

What Causes Epigastric Hernias?

Common culprits enabling epigastric hernia development include:

Prior Abdominal Surgeries

• Any large vertical midline laparotomy incision or periumbilical port sites remaining after minimally invasive operations risk eventual weakening, even decades later.

Chronic Raised Intra-abdominal Pressure

• Obesity, ascites fluid, persistent coughing, or heavy lifting pressures routinely test scar integrity over the years.

Aging Degeneration

• Slow weakening of connective tissue tensile strength through collagenous wear and tear mechanisms.

Trauma

• Significant direct blows harming abdominal wall integrity.

Rare Collagen Disorders

• Inheritable conditions like Marfan or Ehlers-Danlos Syndrome.

Carefully examining patient history illuminates personalized epigastric hernia recurrence risks guiding treatment decisions for preventing repeat herniations long-term after surgery.

What Symptoms Present with Epigastric Hernias?

Many small epigastric hernias cause occasional vague pain but no obvious external bulging for years. Patients may describe sensations of fullness, cramping, or tightness across the upper abdomen. Eventually enlarging hernias will elicit:

• Noticeable Bulge – Skin protrusion centers above or near the navel without groin/inguinal involvement. Often enlarges throughout days then reduces somewhat when lying recumbently overnight as gravitational forces temporarily lessen.
• Pain/Discomfort – Aching, heaviness, or perceived muscle strain. Typically exacerbates as hernias expand. Usually reduces with rest and recumbency.
• Pressure – Dull intra-abdominal heaviness, tightness, crammed feeling, or periumbilical pinching.

Significant tenderness, lymphadenopathy, erythema, rapid enlargement, or systemic illness rarely indicate emergent strangulation as fatty based epigastric tissues generally preclude vascular compromise like intestinal incarcerations. Still, progressive epigastric hernia expansion risks bowel involvement eventually.

When Should You See a Doctor for an Epigastric Hernia?

An epigastric hernia will not heal on its own. Only surgery can repair the condition. In children, surgery can be postponed until the child reaches an older age. For adults, it's common to be diagnosed with an epigastric hernia that originated earlier in life. The hernia may have been present for years without you being aware of it. For many, these hernias produce no symptoms until later in life.

Certain conditions and factors can produce epigastric hernia symptoms, such as obesity, strain, and muscle weakness.

You should see a doctor immediately about your epigastric hernia if the tissue protruding through your ab wall gets stuck in an “out” position. Doctors refer to this as an incarcerated hernia. This means the tissue is trapped within the abdominal wall. When this happens, you are at risk for tissue strangulation. That means the intestinal tissue poking through the muscle wall is cut off from its blood supply. Emergency surgery is needed at this stage.

Determining the Best Timing for Epigastric Hernia Repair

The ideal timing for epigastric hernia repair remains somewhat debatable with mixed data implications. Some clinicians support early intervention upon diagnosis in eligible patients since progressive enlargements increase surrounding tissue attenuation and risks over time. However, other expert consensus guidelines suggest delaying repairs until clear symptoms develop or hernias approach >2cm large given the largely benign natural history for those without complicating comorbidities [9]. Customary surgical thresholds include:

• Pain impacts normal activity/quality of life
• Defect diameter reaches 2cm
• Enlargement progression over sequential exams
• Preventing risky future strangulations

How Doctors Diagnose Epigastric Hernias

Visual inspection and palpation during physical exams with patients standing rather than lying down readily confirms small tissue protrusions and reducibility through abdominal wall defects. Imaging tests occasionally help quantify murky pathology:

• Abdominal Ultrasound – Quickly defines fascial disruption zones and hernia dimensions dynamic across positioning.
• CT Scan – Further examines abdominal wall integrity when clinical context warrants.

Overall, most general surgery specialists reliably evaluate epigastric hernias through careful physical examinations alone assessing for characteristic findings:

• Midline Protrusion – Upper outer quadrant epigastric location remains typical, unlike inguinal involvement. Often enlarges with standing or lean-forward positional maneuvers.
• Positive Cough Impulse – Light finger pressure internalizes tissue bulging at defect sites.
• Smooth Reducibility – Gently maneuvered contents press back in but remain palpable underneath when supine.

Thin body habitus allows easily visualizing or photographically documenting how hernias change across standing positions. Heavier individuals require deeper palpations delineating fascial defects through characteristic cough/pressure rebound signs.

How is Epigastric Hernia Surgery Performed?