What Is an Epigastric Hernia?

An epigastric hernia occurs when an abdominal muscle weakness allows the peritoneum (the lining of the abdominal cavity) and abdominal fat tissue to push through the muscle wall. Epigastric hernias can be congenital (present at birth), yet many epigastric hernias are diagnosed in adults during tests for other issues because they never caused symptoms.

This article describes the symptoms of epigastric hernia and who's at risk. It explains how the condition is diagnosed and treated, including severe cases requiring surgery to correct displacement of tissue that moves through the hole in the muscle.

Risk Factors of Epigastric Hernias

Risk factors for epigastric hernias include:

• Diabetes
  
• Smoking
• Lifting heavy weights or objects
• Strenuous activities
• Being overweight
• Steroid use
• A previous pregnancy
  

These conditions and activities weaken abdominal muscles and stretch the abdominal wall, which can cause epigastric hernias.

Epigastric Hernia Symptoms

Epigastric hernias may seem to appear and disappear, which is referred to as a reducible hernia. The hernia may not be noticeable unless the patient is crying, pushing to have a bowel movement, or another activity that creates abdominal pressure.

The visibility of a hernia makes it easily diagnosable, often requiring no testing outside of a physical examination by a physician. Your doctor can usually diagnose a hernia with a physical exam and a thorough medical history.

However, they may use an ultrasound or other tests to rule out other conditions.

Treatment in Children

An epigastric hernia will not heal by itself and does require surgery to be repaired. It is similar to an umbilical hernia, except the umbilical hernia forms around the belly button and the epigastric hernia is usually between the belly button and the chest.

However, unless the hernia threatens to become an emergency, surgery can be postponed until the child is older. Toddlers tend to tolerate surgery better than newborns, so it may be beneficial to wait before surgery is performed.

Treatment in Adults

It is not uncommon for an adult to be diagnosed with an epigastric hernia that they were unaware of earlier in life. It is also possible for a hernia that was known to be present for many years to become an issue as the individual ages.

For many, a hernia does not cause symptoms until later in life due to obesity, muscle weakness, or strain on the muscular wall of the abdomen. In these cases, surgical repair may be necessary if the hernia is causing pain or threatens to become strangulated.

When an Epigastric Hernia Is an Emergency

A hernia that gets stuck in the out position (incarcerated hernia) is considered an emergency.

An incarcerated hernia can become a strangulated hernia, where the tissue that bulges outside of the muscle is being starved of its blood supply. This can cause the death of the tissue that is bulging through the hernia.

Each of these requires immediate medical attention.

Surgery

Epigastric hernia surgery is typically performed using general anesthesia and can be done on an inpatient or outpatient basis.

This surgery is performed by a general surgeon. If the patient is a child, a surgeon who specializes in pediatrics typically performs the procedure.

Before Surgery

Your healthcare team will discuss the surgery with you and what steps you need to take to prepare for your procedure. This process may begin weeks in advance of your procedure.

For example, research shows that smoking cessation four weeks ahead of surgery, as well as weight loss in obese patients, can reduce the risk of surgical-site infection and improve healing times. In some cases, you may be prescribed antibiotics to take ahead of your surgery.

Your healthcare providers will explain the procedure to you and give you precise instructions about what (and whether) to eat or drink ahead of your appointment. They also may adjust medications that you normally take.

Be sure that you understand what type of surgery you'll have and the type of facility where it will be done, including information that may be needed by your insurance provider. If you will be leaving after outpatient surgery, make sure your transportation plans are in place so that you have someone to drive you after you're given anesthesia.

During Surgery

Once anesthesia is given, surgery begins with an incision on either side of the hernia. A hernia can be repaired via an incision below the hernia, or laparoscopically/robotically with small incisions.

The surgeon then isolates the portion of the abdominal lining that is pushing through the muscle. This tissue is called the hernia sac. The surgeon returns the hernia sac to its proper position, then begins to repair the muscle defect.

If the defect in the muscle is small, it may be sutured closed. The sutures will remain in place permanently, preventing the hernia from returning.

For large defects, the surgeon may feel that suturing is not adequate. In this case, a mesh graft will be used to cover the hole. The mesh is permanent and prevents the hernia from returning, even though the defect remains open.

If the suture method is used with larger muscle defects (approximately the size of a quarter or larger), the chance of recurrence is increased. The use of mesh in larger hernias is the standard of treatment; however, it may not be appropriate if the patient has a history of rejecting surgical implants or a condition that prevents the use of mesh.

Once the mesh is in place or the muscle has been sewn, the laparoscope is removed and the incision can be closed. The incision can be closed in one of several ways. It can be closed with sutures that are removed at a follow-up visit with the surgeon, a special form of glue that is used to hold the incision closed without sutures, or small sticky bandages called steri-strips.

Recovery

Most hernia patients are able to return to their normal activity within six weeks. Older patients may take longer to recover.

The abdomen will be tender, especially for the first week. During this time, the incision should be protected during activity that increases abdominal pressure by applying firm but gentle pressure on the incision line.

Protect the incision during activities such as:

• Moving from a lying position to a seated position, or from a seated position to standing
• Sneezing
• Coughing
• Crying, especially if the child turns red in the face from the effort
• Bearing down during a bowel movement
• Vomiting

Summary

An epigastric hernia happens when part of the abdominal tissue, or an organ in the abdomen, pushes through a weak spot in the abdominal muscle. It can occur in both adults and children, often causing no symptoms but clearly visible at the spot where the hernia is.

Sometimes, a healthcare provider will opt for "watchful waiting" once an epigastric hernia has been diagnosed. But surgery will be needed if the epigastric hernia starts to cause pain, or in an emergency situation such as strangulation that leads to tissue death.

Most people recover well from an epigastric hernia repair, although it may take longer in older adults, smokers, or people living with obesity. Talk to your healthcare provider about your treatment options and what to expect.