Table of ContentsView AllTable of ContentsRisk FactorsSymptomsTreatment in ChildrenTreatment in AdultsWhen It’s an EmergencySurgery
Table of ContentsView All
View All
Table of Contents
Risk Factors
Symptoms
Treatment in Children
Treatment in Adults
When It’s an Emergency
Surgery
An epigastricherniaoccurs when an abdominal muscle weakness allows theperitoneum(the lining of the abdominal cavity) and abdominal fat tissue to push through themuscle wall.Epigastric hernias can be congenital (present at birth), yet many epigastric hernias are diagnosed in adults during tests for other issues because they never caused symptoms.
This article describes the symptoms of epigastric hernia and who’s at risk. It explains how the condition is diagnosed and treated, including severe cases requiring surgery to correct displacement of tissue that moves through the hole in the muscle.
Verywell / Laura Porter
Risk Factors of Epigastric Hernias
Risk factors for epigastric hernias include:
These conditions and activities weaken abdominal muscles and stretch the abdominal wall, which can cause epigastric hernias.
Epigastric Hernia Symptoms
Epigastric hernias may seem to appear and disappear, which is referred to as a reducible hernia. The hernia may not be noticeable unless the patient is crying, pushing to have a bowel movement, or another activity that creates abdominal pressure.
However, they may use an ultrasound or other tests to rule out other conditions.
However, unless the hernia threatens to become an emergency, surgery can be postponed until the child is older. Toddlers tend to tolerate surgery better than newborns, so it may be beneficial to wait before surgery is performed.
It is not uncommon for an adult to be diagnosed with an epigastric hernia that they were unaware of earlier in life. It is also possible for a hernia that was known to be present for many years to become an issue as the individual ages.
For many, a hernia does not cause symptoms until later in life due to obesity, muscle weakness, or strain on the muscular wall of the abdomen. In these cases, surgical repair may be necessary if the hernia is causing pain or threatens to become strangulated.
When an Epigastric Hernia Is an Emergency
A hernia that gets stuck in the out position (incarcerated hernia) is considered an emergency.
An incarcerated hernia can become a strangulated hernia, where the tissue that bulges outside of the muscle is being starved of its blood supply. This can cause the death of the tissue that is bulging through the hernia.
Each of these requires immediate medical attention.
Epigastric hernia surgery is typically performed usinggeneral anesthesiaand can be done on aninpatientoroutpatientbasis.
Before Surgery
Your healthcare team will discuss the surgery with you and what steps you need to take to prepare for your procedure. This process may begin weeks in advance of your procedure.
For example, research shows that smoking cessation four weeks ahead of surgery, as well as weight loss in obese patients, can reduce the risk of surgical-site infection and improve healing times.In some cases, you may beprescribed antibioticsto take ahead of your surgery.
Your healthcare providers will explain the procedure to you and give you precise instructions about what (and whether) to eat or drink ahead of your appointment. They also may adjust medications that you normally take.
4 Main Types of Anesthesia and How They’re Used
During Surgery
Once anesthesia is given, surgery begins with an incision on either side of the hernia. A hernia can be repaired via an incision below the hernia, orlaparoscopically/robotically with small incisions.
The surgeon then isolates the portion of the abdominal lining that is pushing through the muscle. This tissue is called the hernia sac. The surgeon returns thehernia sacto its proper position, then begins to repair the muscle defect.
If the defect in the muscle is small, it may besuturedclosed. The sutures will remain in place permanently,preventing the herniafrom returning.
For large defects, the surgeon may feel that suturing is not adequate. In this case, a mesh graft will be used to cover the hole. The mesh is permanent and prevents the hernia from returning, even though the defect remains open.
If the suture method is used with larger muscle defects (approximately the size of a quarter or larger), the chance of recurrence is increased. The use of mesh in larger hernias is the standard of treatment; however, it may not be appropriate if the patient has a history of rejectingsurgical implantsor a condition that prevents the use of mesh.
Once the mesh is in place or the muscle has been sewn, the laparoscope is removed and the incision can be closed. The incision can be closed in one of several ways. It can be closed with sutures that are removed at a follow-up visit with the surgeon, a special form of glue that is used to hold the incision closed without sutures, or small sticky bandages called steri-strips.
Recovery
Most hernia patients are able to return to their normal activity within six weeks.Older patientsmay take longer to recover.
Protect the incision during activities such as:
Summary
An epigastric hernia happens when part of the abdominal tissue, or an organ in the abdomen, pushes through a weak spot in the abdominal muscle. It can occur in both adults and children, often causing no symptoms but clearly visible at the spot where the hernia is.
Sometimes, a healthcare provider will opt for “watchful waiting” once an epigastric hernia has been diagnosed.But surgery will be needed if the epigastric hernia starts to cause pain, or in an emergency situation such as strangulation that leads to tissue death.
Most people recover well from an epigastric hernia repair, although it may take longer in older adults, smokers, or people living with obesity. Talk to your healthcare provider about your treatment options and what to expect.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Healthdirect Australia.Epigastric hernia repair (adult).Brigham and Women’s Hospital.What is an umbilical or epigastric hernia?.NYU Langone Health.Diagnosing hernia in adults.Wolf LL, Ejiofor JI, Wang Y, et al.Management of Reducible Ventral Hernias: Clinical Outcomes and Cost-effectiveness of Repair at Diagnosis Versus Watchful Waiting.Ann Surg. 2019;269(2):358. doi:10.1097/SLA.0000000000002507Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J,et al.Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society.Br J Surg. 2020 Feb;107(3):171-190. doi:10.1002/bjs.11489.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Healthdirect Australia.Epigastric hernia repair (adult).Brigham and Women’s Hospital.What is an umbilical or epigastric hernia?.NYU Langone Health.Diagnosing hernia in adults.Wolf LL, Ejiofor JI, Wang Y, et al.Management of Reducible Ventral Hernias: Clinical Outcomes and Cost-effectiveness of Repair at Diagnosis Versus Watchful Waiting.Ann Surg. 2019;269(2):358. doi:10.1097/SLA.0000000000002507Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J,et al.Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society.Br J Surg. 2020 Feb;107(3):171-190. doi:10.1002/bjs.11489.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Healthdirect Australia.Epigastric hernia repair (adult).Brigham and Women’s Hospital.What is an umbilical or epigastric hernia?.NYU Langone Health.Diagnosing hernia in adults.Wolf LL, Ejiofor JI, Wang Y, et al.Management of Reducible Ventral Hernias: Clinical Outcomes and Cost-effectiveness of Repair at Diagnosis Versus Watchful Waiting.Ann Surg. 2019;269(2):358. doi:10.1097/SLA.0000000000002507Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J,et al.Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society.Br J Surg. 2020 Feb;107(3):171-190. doi:10.1002/bjs.11489.
Healthdirect Australia.Epigastric hernia repair (adult).
Brigham and Women’s Hospital.What is an umbilical or epigastric hernia?.
NYU Langone Health.Diagnosing hernia in adults.
Wolf LL, Ejiofor JI, Wang Y, et al.Management of Reducible Ventral Hernias: Clinical Outcomes and Cost-effectiveness of Repair at Diagnosis Versus Watchful Waiting.Ann Surg. 2019;269(2):358. doi:10.1097/SLA.0000000000002507
Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J,et al.Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society.Br J Surg. 2020 Feb;107(3):171-190. doi:10.1002/bjs.11489.
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