What is an Epigastric Hernia?
Epigastric hernia (white line hernia) is a form of hernia that develops in the epigastrium, in the abdomen area, between the navel and sternum. It occurs three times more often in men compared to women. It is an uncommon form of hernia, as it occurs in about 2-3% of the total population, usually at the age of 30 to 40 years.
How does an epigastric hernia develop?
An epigastric hernia is the “lump” located at the top of the abdominal wall, the epigastrium. The appearance of the “bulge” is the result of projection of an intra-abdominal organ through the white line. The white line is in the middle of the abdomen and is created by the fusion of the root canals of the two rectus abdominis muscles. For this reason, epigastric hernia extends from the sternum to the navel.
An epigastric hernia can form anywhere on the white line, and its size varies. Most often it has a small size (3-4 cm) and visually resembles a lipoma.
It is important to differentiate it from another similar condition that is not a true hernia. This condition is called white line diastasis or divarication of the recti muscle and although it can coexist with epigastric hernia, on its own it does not require immediate treatment, unless aesthetic reasons arise. However, it is a predisposing factor for the appearance of epigastric hernia.
What can cause an epigastric hernia?
Epigastric hernia occurs when the muscular wall of the anterior abdominal wall weakens, resulting in a gap within the muscle groups.
The causes of weakening of the abdominal wall are associated with an increase in intra-abdominal pressure. It is possible that hereditary predisposing factors coexist, but it is usually caused due to daily activities, such as:
- intense manual work or exercise
- Injuries
- severe cough
- weight lifting
- obesity
- great weight loss
- Diastasis of rectus abdominis muscle
Therefore, the weakening of the abdominal wall in combination with an increase in intra-abdominal pressure, lead to the appearance of epigastric hernia.
Symptoms and clinical signs of epigastric hernias
People with epigastric hernia often experience discomfort and sometimes pain when performing a movement. As noted, epigastric hernia is evident in the area above the navel as a lipoma-like bloating. There are cases when patients may notice more than one hernia.
Usually, the hernia is amenable to reduction, i.e., the viscera it contains can return to its place, especially when the patient is in a supine position. In more advanced cases, the epigastric hernia remains constantly protruding, causing progressive symptoms such as local tenderness, hardness and pain.
Diagnosis of epigastric hernias
The diagnosis of epigastric hernia is carried out in the following ways:
- Physical examination by a general surgeon who specializes in hernia treatment, examining the patient in an upright and inclined position.
- Abdominal ultrasound
- CT scan or abdominal MRI
However, the presence of local swelling in the epigastrium area is the main indication of epigastric hernia.
What is the treatment of epigastric hernia?
Treatment of epigastric hernia is only surgical. With the application of minimally surgical methods, the operation to repair an epigastric hernia is performed with great success and safety for the patient.
Laparoscopic repair with the placement of a special mesh is the most common choice. The surgeon makes small incisions a few millimetres in diameter, through which the laparoscope is inserted. A laparoscope is a thin tube with a custom camera that emits light and allows the surgeon to survey the abdominal organs and hernia. Next, the hernia is reduced, that is, its contents return to its normal position, and surgery is completed, when the gap of the hernia is covered by the placement of a mesh.
The advantages of this method compared to open surgery are many, the main ones being the following:
- minimal postoperative pain.
- Rapid recovery and immediate return to daily activity.
- lower rates of complications and relapse.
- better aesthetic result, through minimal incisions that leave no marks or scars.
- drainage tubes are almost never fitted.
- Same day discharge from hospital.
