Epigastric Hernia Surgery

The muscular abdominal wall is a work of artistic engineering. Despite this brilliant human anatomical design, there are areas of potential weakness. Hernias can develop between the intersecting fibers of the “Linea Alba” and over time they can enlarge.

It is not absolutely necessary to repair small epigastric hernias when they cause no symptoms. Certainly if they are the cause of discomfort or pain then surgery is very appropriate.

Epigastric hernia repair is a surgical procedure that reconstructs the hole in the abdominal wall with either sutures and/or a mesh material. It usually can be accomplished in an outpatient setting.

Epigastric hernia repair is a surgical procedure for the removal of an epigastric hernia that has been detected by a physician.

Repairing an epigastric hernia is an outpatient surgery and is one of the safest hernia repair techniques.

Given their typical small size of the defect (usually less than 2 cm) , they can be fixed through a small incision often without the use of synthetic mesh. The surgery is outpatient and can be performed in a surgery center.

General Surgeons and some plastic surgeons are the doctors that diagnose and treat epigastric hernia patients. The treatment could range from observation without surgery to open or robotic surgery.

Coughing or sneezing can aggravate epigastric hernias due to the sudden increase in intraabdominal pressures they cause. This increase in pressure can aggravate what is already going through the hernia (typically fat) by pushing it out of the hernia defect further. This can cause pain or discomfort and potentially make the hernia larger.

An epigastric hernia can feel like a lipoma (small fatty mass) or even a sebaceous cyst. Interestingly, lipomas and sebaceous cysts rarely occur in the upper midline location of epigastric hernias. Thus, small (less than 3 cm) soft tissue masses in the upper midline (linea alba) are most commonly epigastric hernias.

Epigastric hernia repair is typically one of the simplest and safest operations among all hernia procedures. It is an operation that takes less than one hour and can be performed outpatient in a hospital or surgery center. It is usually performed under general anesthesia. It can be performed with conventional open techniques or with the latest robotic technology.

The conventional open technique is the most common and appropriate technique for typical small epigastric hernias. It involves a small incision over the hernia. The incision is made as small as possible with an emphasis on an optimal cosmetic outcome. The hernia is exposed with delicate and meticulous technique. After complete exposure of the hernia defect and reduction of the hernia contents, the hernia is repaired with a sewing technique without the use of mesh and in some cases mesh is used to help prevent the risk of hernia recurrence. The use of mesh in epigastric hernias remains a topic of great controversy among hernia specialists. After repair of the hernia defect, the subcutaneous tissue and skin is reconstructed with a strong emphasis on optimal cosmetic outcome.

The robotic repair is a minimally invasive technique appropriate for larger epigastric hernias. This involves general anesthesia and three half inch incisions on the right or left side of the abdomen. An ultra high definition 3d camera is inserted through one of the incisions and different instruments (scissor, clamps, or sewing needle holders) are inserted through the other two incisions. The camera and the instruments are attached to a robotic arm system. The surgeon controls everything while sitting in a console with a 3D viewer and sophisticated hand controls and multiple foot pedals. Ultimately the hernia is well exposed and sewn closed and usually a mesh is sewn below the area to reinforce the repair. The technology allows for unsurpassed vision and delicacy in the repair that yields a less painful result than laparoscopic surgery from the recent past.

Most people will experience some degree of pain or discomfort after the surgery that will delay returning to office-type work for a day or two.

Depending on the size of the hernia many can return to physical activities within weeks of the operation.

The abdominal hernia surgery recovery time may vary from person to person, but most patients can expect to recover completely within 6 to 8 weeks after the surgery. However, it is important to follow your doctor’s instructions and monitor your progress regularly

No- most epigastric hernias are not considered major surgery and patients go home the same day.

Many people can live with a hernia for their whole lives. Many choose to have their epigastric hernia repaired due to discomfort or pain, enlargement, or to eliminate the risk of emergency incarceration and strangulation.

No. Epigastric hernia repair is uniformly an outpatient operation.

It can be performed in a hospital or a surgery center.

If possible, optimize weight to achieve close to ideal body weight.

The average hernia recovery time depends on the type and location of the hernia, as well as the surgical technique used.

If one’s weight is significantly more than ideal, it is often beneficial to lose weight prior to epigastric hernia repair.