Hernia Repair - Epigastric

About the Procedure

Epigastric Hernia Repair (Herniorrhaphy; Hernioplasty) is a surgical procedure to resolve a herniated area occurring in the upper abdomen, usually over the stomach. This type of hernia occurs when the muscles and tendons supporting the contents of the abdominal organs begin to develop an area of weakness allowing the tissue underneath to push up through the hole. The need to medically address the hernia depends on what tissue has come through; if it becomes infected or strangulated (loss of blood flow to the tissue); if the patient experiences a level of discomfort; or if the bulge becomes visible causing a cosmetic concern. A hernia does not repair itself and the majority will require surgical correction at some point.

The repair may be performed laparoscopically or through a traditional surgical incision. While the laparoscopic method has become the standard, some medical organizations oppose its use believing the meticulous skill required by the surgeon increases the risk of inadvertently cutting nearby vital ducts, arteries, and organs; and that these risks outweigh the many positive features of the newer method.

The procedure involves pushing the bulging tissue back through the weakened space in the muscle and then repairing the gap in the muscle to prevent a reoccurrence. In a technique referred to as "tension-free", a mesh graft is placed over or under the hole in the muscle, preventing the tissue from bulging through even though the hole remains. It decreases the possibility of a re-opening of the weakened area resulting in another hernia. There is a higher incidence of infection when the mesh is used, especially in patients with immune system disorders. The graft is a foreign item with a risk of rejection which, should it occur, would require a second surgery.

What to Know Before the Procedure

Hernias occur in children as well as adults making early education and preparation especially important. A child may be intimidated by the hospital environment and find the operating room frightening. Comforting, supportive attention is important to the success of the operation and post-operative care, in particular, restrictions on resuming physical activities. A pediatric general surgeon or a pediatric colorectal specialist is recommended to perform the procedure on children.

Preparation for this procedure is similar to other operations. A health assessment, blood work, x-rays, adding or changing medications to avoid excess blood loss during the operation, and pre-operative instructions on food and water intake will be provided by the doctor. Advanced planning for a ride at discharge and assistance at for the first day is recommended because pain and tiredness are the chief complaints at that time.

What to Know After the Procedure

Epigastric Hernia Repairs are often done in an out-patient facility and the patient is discharged the same day after a period of observation. Some procedures, such as the traditional incision method, may require an in-patient stay with discharge dependent on the complexity of the surgery, complications and recovery progress. Low level physical activity/exercise may be resumed immediately, moderate activity within a week, and return to pre-surgery activity at about 14 days following the laparoscopic procedure. Some tenderness around the surgical site and discomfort when activities involve pressure on the abdomen, e.g., lifting, sneezing, coughing, etc. are to be expected. The more invasive surgical method requires a much longer recovery and an extended period of restricted physical activity.

If you Need to Travel Outside of your Local Hospital

Laparoscopic surgery requires a skilled and experienced surgeon to avoid complications and should be a significant factor in determining where the procedure is to be performed. Consideration should be given to the limits of the healing process and the patient's level of comfort following the surgery. While most patients are able to return to low-level activity quickly, speak with your doctor about appropriate recovery times and travel restrictions. When deciding to have this procedure performed abroad, be sure to speak with your doctor about post-operative care as well as what to do in the event that follow-up treatment is necessary after you have left their country of residence.