An Epigastric hernia is a protrusion normally seen noted between the xiphoid process (breast bone) and the umbilicus (navel) as a result of weakness or opening of the underlying muscles or tendons.
Who commonly presents with it?
Any person can present with an epigastric hernia but it is more common in men and has a strong association with obesity.
How does it present?
An epigastric hernia is usually asymptomatic but can present with pain and/or a notable lump just below the breastbone. The hernia can be aggravated by exercise and eating at times. On rare occasions if small it can also become very painful and irreducible (incarcerated). Usually it will contain fat overlying the bowel (extraperitoneal fat) but can also contain bowel in which case it managed as a surgical emergency (strangulated hernia).
What can be done?
If relatively asymptomatic they can be left alone. Small epigastric hernia, because of the risk of incarceration or strangulation are often offered surgical repair. Surgery involves an incision over the lump and closure of the defect with simple sutures. In some cases the repair is reinforced with a mesh. Smaller epigastric hernia can also be repaired under Local Anaesthesia. In larger patients (obese) it may be beneficial to undertake the repair by keyhole technique. This technique will remove the need for a larger up to 10 cm incision with the repair only requiring one 10mm and x2 5mm incisions.
How long will your recovery take?
Recovery is very quick, with most patients being discharged the same day. Complete recovery is based on individual needs and fitness of the patient. Patients are encouraged to start mobilising gently immediately after surgery and refrain from lifting heavy objects for at least one week. A return to full activities is expected within 2 weeks. Larger patients that are offered the keyhole repair will experience quicker recovery and return to normal activities, as the incisions used will be smaller than an open repair.
What are the main risks of surgery?
Your surgeon will advise on any specific complications and risks. For all types of surgery there is always a risk of wound infection and a 1-2% risk of recurrence of the hernia.