Epigastric hernias occur in the midline, between the umbilicus and the breast bone. They are about three times more likely to occur in men than women.
Symptoms of epigastric hernia
Epigastric hernias usually present with a bulge in the upper central part of the abdomen (the epigastrium). This may be not be painful but most people suffer discomfort. The lump may disappear when lying down and may not be as obvious when waking in the morning. Sometimes an epigastric hernia causes pain which is related to eating. Symptoms can be worsened when coughing, sneezing, or when taking exercise.
Causes of epigastric hernia
There may be no obvious cause but epigastric hernias may be more common in association with heavy lifting, straining (constipation or difficulty in passing urine), pregnancy or with exercise.
Treatment of epigastric hernia
Small epigastric hernias which cause few symptoms do not always need surgery. They are at low risk of incarceration, obstruction or strangulation (which necessitates emergency surgery). Larger hernias should be repaired.
Epigastric hernia repair is a day case operation meaning that no overnight stay in hospital is necessary. These repairs are usually carried out under general anaesthetic. The Berkshire Hernia Centre offers different approaches to epigastric hernia repair;
1. The conventional (or open) approach involves a small incision just above the swelling. The weakness in the abdominal wall is repaired and either non- dissolving sutures or a nylon mesh are used to reduce the risk of the hernia coming back. The incision is closed with an invisible dissolving stitch.
2. A laparoscopic (keyhole) repair is carried out from within the abdomen. Very small incisions are made in the abdominal wall to enable specialist keyhole instruments to be inserted. These are then used to repair the weakness and insert a nylon mesh.
Your surgeon will discuss these options with you.
You will usually have a pre-op assessment in the week before surgery where blood tests, chest X-ray and an ECG (heart recording) may be taken. You will be admitted a few hours before the approximate planned time of surgery having had nothing to eat for six hours before the start time (you may drink water up to two hours before your proposed time of surgery – with any of your regular medications). You will see your surgeon and the anaesthetist before your operation.
After your surgery you will wake up in the recovery room, and then be transferred back to the ward. Later the same day you may have something to eat and drink if you wish. Most people are discharged home later the same day.
You will be provided with painkillers before discharge but it is recommended that you take regular paracetamol and ibuprofen (unless you are sensitive to these) after a few days of these. Stronger painkillers such as cocodamol may be necessary but if so it is important to take a laxative such as lactulose at the same time. You can expect to have some discomfort after surgery, but this will rapidly subside and most people are able to resume normal activities within a week of surgery. It may be slightly more uncomfortable for longer if you have had an open procedure. With both types of surgery there will still be minor twinges for sometime as the tissues organize themselves. You will be able to take gentle exercise but should avoid heavy lifting or strenuous work for 2 weeks. You may drive a car when you are able to perform an emergency stop safely.There are no stitches to be removed.
You will be seen for follow-up six weeks following your surgery.
Risks of surgery
There are very few potential complications.You may develop some bruising around the wound which can take a while to settle. If the wound swells, becomes more painful and hot, or starts to discharge, you may have a wound infection and should contact the Berkshire Hernia Centre or your General Practitioner. The risk of recurrence is around 1-2%.