Epigastric hernias account for about 2-3% of all abdominal hernias. Abdominal hernias are holes in the lining of the abdominal cavity or belly through which fat and eventually intestine pokes out. Epigastric hernias are defined by their location. They stick out from the midline of the front of the belly between the belly button and the bottom of the breast bone or sternum. These hernias should be distinguished from hernias in the same location that occur through openings where prior surgery has taken place. Hernias through previously used abdominal surgical scars are known as incisional hernias.
Epigastric hernias can cause no symptoms at all or can be uncomfortable. When epigastric hernias cause symptoms it is usually discomfort or pain at the site of the lump. The pain ranges from very mild discomfort to severe pain. Occasionally when the fat coming out of the belly through the hernia is squeezed very tight by the tiny hernia opening, the fat can become very inflamed and extremely painful. The lump can be reducible in that it can be pushed back completely into the belly or it could be nonreducible(incarcerated hernia) in which case the fat is stuck and cannot be pushed back.
Treatment for an epigastric hernia is necessary if the epigastric hernia is causing symptoms. Surgery is the only effective treatment for epigastric hernias. All epigastric hernia repairs need to be performed in an operating room with the person asleep under an anesthetic. When the hernias are small, around 1 cm in size or less , they can be fixed with stitches alone to pull the muscle lining together and close the hernia defect or hole. This can be performed through a small incision directly over the hernia. When hernias are larger they require repair using some form of surgical cloth or mesh. We performed these types of repairs using minimally invasive laparoscopic or robotic surgery. This involves making 3 tiny incisions at the side of the belly and inserting a lighted scope and long instruments through the tiny incisions. Either using laparoscopy or robotic surgery the hernia is closed with stitches and then surgical mesh is placed underneath the repair to prevent a recurrence.
Recovery after epigastric hernia repair is usually straightforward with soreness lasting for a few days followed by a gradual return to full normal activity. After repair of epigastric hernias, it is very unlikely that the hernia will ever come back
