A hernia occurs when the inner layers of the abdominal muscles have weakened, resulting in a weak spot. As a result of this condition, an intra-abdominal organ protrudes through the weakened area of the abdominal wall, forming a small bulge. This may allow a part of the intestine or intra-abdominal fat to push through or even become trapped within the gap in the abdominal wall. A hernia can develop at any point in the abdominal wall, and its name depends on its specific location. Specifically, an epigastric hernia develops in the epigastrium, which is the upper part of the abdomen, above the navel.
What is an epigastric hernia?
An epigastric hernia, also known as a linea alba hernia, is a type of hernia that develops in the midline of the anterior abdominal wall. It is located in the area between the xiphoid process and the umbilicus, where the aponeuroses of the rectus abdominis muscles join. Through the gap that is created, intra-abdominal organs, such as parts of the small intestine or the appendix, protrude.
Etiology and risk factors
The occurrence of an epigastric hernia is associated with the systematic exertion of intra-abdominal pressure, which leads to the stretching and weakening of the muscles along the linea alba. The same applies to other types of hernias, such as an inguinal hernia and an umbilical hernia. Increased intra-abdominal pressure is more common in individuals who strain their abdominal wall, such as athletes who engage in intense training, manual laborers, and women after pregnancy. Additionally, factors like aging and obesity contribute to the gradual relaxation of the epigastric area, making the abdominal wall more vulnerable to hernia formation.
Pathogenesis
The linea alba, the point where the aponeuroses of the rectus abdominis muscles join, is a particularly strong but relatively vulnerable zone under increased pressure. Continuous strain or a sudden event, such as lifting heavy objects, can cause a rupture or opening in this area, allowing intra-abdominal organs to protrude. Initially, the hernia may be small, but over time, it can significantly increase in size, leading to the formation of a permanent bulge.
Symptoms that an epigastric hernia causes
Patients with an epigastric hernia typically report the presence of a small protrusion in the upper part of the abdomen, above the navel. In the early stages, the bulge may spontaneously reduce or be pushed back with gentle pressure, becoming more noticeable during activities that increase intra-abdominal pressure, such as coughing, lifting weights, or intense physical activity. Over time, the bulge may become permanent and more difficult to reduce. It is often accompanied by pain or a sensation of heaviness in the area, while after large meals, symptoms such as nausea, vomiting, and significant abdominal discomfort may occur.
Potential complications
One of the most serious complications of an epigastric hernia is strangulation, in which a portion of an intra-abdominal organ becomes trapped within the hernia opening. In this case, the blood supply to the organ is cut off, leading to ischemia and potentially necrosis. Strangulation is a medical emergency that requires immediate surgical intervention to release the trapped organ and preserve its integrity.
Diagnosis
The clinical examination by an experienced general surgeon is crucial for diagnosing an epigastric hernia. The protrusion becomes more noticeable when the patient coughs or gets up from bed, while it may recede when lying down. In many cases, an epigastric hernia can be mistaken for lipomas of the abdominal wall or diastasis recti. Diastasis recti is a condition in which the rectus abdominis muscles separate widely without an actual rupture of the linea alba. Unlike a hernia, diastasis recti is not an absolute indication for surgical repair, as it is primarily considered a cosmetic issue rather than a functional problem.
To confirm the diagnosis and plan the surgical procedure that usually follows, a dynamic ultrasound examination of the abdominal wall is often performed. This examination not only confirms the presence of the hernia but also reveals any coexisting smaller hernias or disorders of the linea alba.
Treatment of an epigastric hernia
The treatment of an epigastric hernia is primarily surgical, as the hernia defect will not close on its own. The surgery aims to reduce the protruding organs and close the abdominal wall defect. The closure can be performed either through primary suturing or with the use of a mesh, especially when the defect exceeds 2 centimeters. The mesh provides reinforcement to the area and significantly reduces the risk of recurrence. However, if the hernia defect is smaller than 5 centimeters, it can often be closed using absorbable sutures, without the need for mesh placement.
The surgery can be performed either through open surgery or laparoscopically. The laparoscopic technique is now widely preferred as it is a minimally invasive method that offers significant advantages, such as:
- Faster hospital discharge
- Less postoparative pain
- Faster return to daily activities
- Excellent aesthetic result due to the small size of the incisions made, which do not leave visible scars.
Although epigastric hernias are less common compared to other abdominal wall hernias, they require special attention due to the risk of strangulation and associated complications. Early diagnosis and timely surgical repair not only ensure the well-being of the patient but also help prevent recurrences.
It is crucial for patients with a hernia not to delay treatment, assuming that the absence of significant symptoms means there is no risk. The earlier the surgical intervention, the lower the chances of complications. The General Surgeons in Athens that are a part of the Colon Rectal team have extensive experience in repairing all types of hernias, ensuring the health and well-being of every patient.
