Hongkong Hernia Centre

Epigastric Hernia

Introduction What are the signs and symptoms? Do epigastric hernias need surgery? What are the surgical options? How long does it take to recover after an epigastric hernia repair?


Introduction top

Epigastric hernias arise from defects which can occur anywhere in the midline fibrous tissue (linea alba) between the bottom of the rib cage and the umbilicus.  They are often small and cause no symptoms.  They may therefore remain undiagnosed for many years.  Post mortem studies suggest that they occur in up to 10% of the general population.  They are rare in children and the diagnosis is most often made in the third to fifth decade of life.  Epigastric hernias affect three times as many males as females.

What are the signs and symptoms? top

Often none as 75% of epigastric hernias are asymptomatic.  The most common presenting feature is that of a lump or swelling in the midline.  Paradoxically it is the smaller hernias which cause more symptoms as the neck of the hernia is narrow and the contents of the hernia tend to be pinched more readily.  The typical pain is epigastric (central upper abdomen) which is made worse with exertion.  However, a wide variety of symptoms need not be readily apparent as relating to an epigastric hernia.  The pain can be dull, burning or colicky with occasional radiation to back, chest or lower abdomen, and may be associated with indigestion, nausea or vomiting

Do epigastric hernias need surgery? top

No.  As most of these hernias (75%) are small and do not causing symptoms.   If the hernia is symptomatic then surgery is indicated.

What are the surgical options? top

They can be easily dealt with by open surgery through a small incision, in the midline overlying the hernia. If the defect is small then an overlapping sutured repair can be effected but if the defect is any greater than 1cm, it is best repaired using a tension free mesh technique placed in the preperitoneal plane so that the mesh does not stick to the intestines.  

How long does it take to recover after an epigastric hernia repair? top

You can have this repaired as a day case or as an overnight stay.  Recovery is usually about 7 days for most patients.  Your ability to drive a car is governed by being able to put your right foot on the brake pedal to perform an emergency stop without inhibition (automatic transmissions) or both feet on the clutch and brake pedals (manual transmissions).  Avoidance of heavy lifting or straining for three months is recommended to allow the tissues to reach their maximal tensile strength and therefore reduce the risk of recurrence.