Information on Epigastric Hernias

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    Day-case surgery is possible for most umbilical hernias

  • Surgery at Ross Hall. Scotland’s premier hopsital

  • As many as 3 in 10 patients who get a hernia on one side will subsequently get a hernia on the opposite side

  • Most patients are fully active within days of the operation

  • We have a highly experienced surgical and nursing team

So, what is an epigastric hernia?

An epigastric hernia is a small hole in the abdominal wall between the sternum and the umbilicus (belly button).

An epigastric hernia occurs when part of the fat or intestine protrudes through a weak spot in the abdominal muscles. It appears as a soft swelling above the area of the navel (umbilicus).

This type of hernia is usually small and often may not cause any pain or discomfort. The size of the opening in the abdominal wall may be quite small so it is often not possible to push the contents of the hernia back inside.

Occasionally, the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of trapped intestine and can lead to tissue death. Emergency surgery may be required. You may also need emergency surgery if you develop signs and symptoms of bowel obstruction. These include abdominal cramps, bloating and vomiting.

Epigastric hernia

Usually a small hernia. It rarely contains bowel and may be difficult to push back due the small size of the defect in the muscle

Epigastric hernias are often small but may cause pain

Who is likely to get an epigastric hernia?

The hernia may also occur in adults, especially in pregnant women or women who had had children in the past. Increasing weight however is the most common reason for the development of an epigastric hernia.

Rarer causes include fluid in the abdomen (ascities). Treatment for adults typically is surgery, especially if the hernia enlarges and causes pain. Hernias rarely go away without treatment.

What are the symptoms of an epigastric hernia?

Most epigastric hernias have no symptoms. The development of pain in an epigastric hernia is a cause for concern as it suggest the the hernia has become incarcerated or trapped.  This can progress and may require emergency surgery.

How are epigastric hernias treated?

In adults, epigastric hernias will not close and may get bigger. This is especially so if increasing weight is the cause and a persons weight continues to rise.

In adults, consideration should be given to closing these hernias if they are causing pain or discomfort or they are increasing in size.

Emergency hernia surgery

Can an epigastric hernia cause a serious problem?

Most abdominal hernias appear suddenly when the abdominal muscles are strained or if you have been standing for some time. You may feel tenderness, a slight burning sensation, or a feeling of heaviness in the bulge. It may be possible to push the hernia back into place with gentle pressure, or the hernia may disappear by itself when you lie down. Being able to push the hernia back is called reducing it. On the other hand, some hernias cannot be pushed back into place, and are termed incarcerated or irreducible.

Most hernias do not cause too much pain and many cause no pain at all. Persistent, severe or increasing discomfort is a worrying feature and might indicate that the hernia has become “stuck” or incarcerated. This situation can progress to the development of tissue damage or even gangrene within the hernia which becomes a surgical emergency. If a hernia becomes increasingly painful which is not relieved by lying down, you should seek immediate medical advice as this might be an indicator that it has become incarcerated.  

Saggital section of an unbilical hernia containing small intestine

What are the surgery options for an epigastric hernia?

Epigastric  hernia surgery is usually performed as a day case, without the need for an overnight stay in hospital. General anaesthesia is usually used although local anaesthetic can be used for small hernias. Surgery is generally performed through a small 2-5 cm incision over the hernia. The procedure involves freeing up the hernia and returning the contents of the hernia (usually fatty tissue) back to the abdomen. The weakness within the abdomen is then repaired. This repair may be reinforced with by a mesh made of a synthetic material that does not irritate the body.

Are there non-surgical options to treat an epigastric hernia?

In adults, the hernia is very unlikely to go away on its own. It may stay unchanged and give rise to similar symptoms that you are currently getting. If left alone, you run the risk that it may get bigger and cause increasing discomfort. There is a small chance that the contents of the hernia could become strangulated. This would require emergency and somewhat more complex surgery with a longer stay in hospital if it occurred.

Want to see a specialist about your hernia?

Contact the Scottish Hernia Centre

What can I expect after epigastric hernia surgery?

Most operations are done as a day case. These patients go home once they have recovered from the anaesthetic. Anyone who has a general anaesthetic will need to arrange for a friend or relative to drive them home and stay with them for the next 24 hours.

A general anaesthetic can temporarily affect co-ordination and reasoning skills, so we advise patients  to avoid driving, drinking alcohol or signing legal documents for 24 hours. Before discharge, we will provide detailed advise about caring for the wound. We usually use invisible wound stitches so there will be no need for stitches to be removed. An appointment for clinic review will also be made (usually around six weeks later).

Whether recovering from open or laparoscopic surgery, it will be necessary to take it easy for the first two or three days. We will give you specific advice about resuming normal activities. In general you should be able to move around freely but should avoid strenuous exercise and lifting for at least the first few weeks. Most people continue to experience some discomfort for a few weeks after surgery, but this will gradually settle.

In experienced hands, the long-term success rate for surgery is high with a less than 5% risk of the hernia coming back again.

Hernia surgery

What are the side-effects or complications of surgery?

Side-effects of surgery:

Side-effects are the unwanted but usually temporary effects of a successful procedure. Examples include feeling sick as a result of the general anaesthetic or painkillers.

Complications of epigastric hernia surgery:

Complications are unexpected problems that can occur during or after the operation. However, most people undergo epigastric hernia without difficulty. As with any surgery, there is a very small risk of developing an unexpected reaction to the anaesthetic. Other rarely encountered problems include excessive bleeding, infection or developing a blood clot within the leg veins (deep vein thrombosis). To help prevent this, most people are given compression stockings to wear during the operation. They may also be given a drug to thin the blood and reduce the risk of clots.

Specific complications of an epigastric hernia repair are uncommon but can include accidental damage to internal organs, which could require a larger incision to repair. There is also a risk of abdominal bruising, although this usually settles without treatment.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. There is a small risk of infection in the mesh which can be difficult to eradicate if it occurs. 

What can I do to avoid an epigastric hernia?

In most instances, there is no specific reason why somebody develops an epigastric hernia. For some, pregnancy and advancing age may be a factor. Lifestyle measures may help to prevent an epigastric hernia from developing. The most important advice is to use lifting equipment for heavy loads. Use safe lifting and carrying techniques and avoid excessive or repeated straining.

Other factors that may help include the following

  • Maintaining muscle strength by taking regular daily exercise
  • Avoiding constipation by eating a healthy high-fibre diet that contains plenty of fruit, vegetables and whole grain cereals, such as wholemeal bread and brown rice
  • Stop smoking
  • Losing weight (if overweight)

Can I undergo epigastric hernia surgery at the Scottish Hernia Centre?

Yes. Richard Molloy undertakes  epigastric hernia surgery on a regular basis at the Scottish Hernia Centre, based at Ross Hall hospital GlasgowAt the initial consultation, your hernia and any other medical problems will be assessed before discussing the surgical options for repair.

The Scottish Hernia Centre in Glasgow is Scotland’s premier private specialist hernia centre, where highly trained nursing and medical staff work within a state of the art hospital enabling our surgeons to safely treat even the most complex hernia within a safe and comfortable high tech environment.