Epigastric Hernia - Umbilical – Abdominal wall hernias

An epigastric hernia is a type of hernia that occurs when fatty tissue or part of the intestine protrudes through a weak area in the abdominal wall between the navel and the breastbone (sternum), known as the epigastrium.

This type of hernia typically appears as a small lump or bulge in the upper abdomen and may cause discomfort or pain, especially when lifting heavy objects or straining.

Causes and Risk Factors
The exact cause of epigastric hernias is often unknown, but they typically occur due to a combination of factors that weaken the abdominal wall. Common causes and risk factors for epigastric hernias include:

1. Weakness in Abdominal Muscles: Epigastric hernias often develop at sites where the abdominal muscles are naturally weaker, such as in the midline between the sternum and the navel.
2. Congenital Defects: Some individuals may be born with congenital weaknesses or defects in the abdominal wall that predispose them to develop hernias later in life.
3. Increased Intra-abdominal Pressure: Activities or conditions that increase pressure within the abdomen, such as obesity, pregnancy, heavy lifting, or persistent coughing, can strain the abdominal muscles and contribute to the development of hernias.
4. Age: As individuals age, the abdominal muscles may weaken, increasing the risk of hernias.
5. Genetics: Family history of hernias or connective tissue disorders may increase the likelihood of developing epigastric hernias.

Symptoms
The symptoms of an epigastric hernia can vary depending on the size and location of the hernia and whether any complications are present. Common symptoms may include:

1. Visible Lump or Bulge: The most prominent symptom of an epigastric hernia is a small lump or bulge in the upper abdomen, typically between the navel and the sternum.
2. Discomfort or Pain: Discomfort or aching sensation in the upper abdomen, especially when lifting heavy objects, straining during bowel movements, or standing for long periods.
3. Nausea and Vomiting: In some cases, epigastric hernias may cause symptoms such as nausea, vomiting, or indigestion, particularly if the hernia compresses nearby organs or disrupts digestive function.

Diagnosis
Diagnosing an epigastric hernia typically involves a physical examination and may include additional imaging tests. Common diagnostic methods may include:

1. Physical Examination: A healthcare provider may perform a physical examination to feel for a lump or bulge in the upper abdomen and assess its size, location, and reducibility (whether it can be pushed back into the abdomen).
2. Ultrasound: An ultrasound scan may be used to visualize the hernia and surrounding structures to confirm the diagnosis and assess for any complications.
3. CT: This is used infrequently if the diagnosis is in doubt and to differentiate between a hernia and rectus diastasis.

Treatment
Treatment for an epigastric hernia depends on the size, location, and severity of the hernia, as well as the presence of symptoms or complications. Treatment options may include:

1. Watchful Waiting: In cases where the hernia is small, asymptomatic, and not causing complications, a healthcare provider may recommend watchful waiting and monitoring for any changes in size or symptoms.
2. Laparoscopic Surgery: In some cases, minimally invasive laparoscopic surgery may be performed, involving small incisions and the use of a camera and specialized instruments to repair the hernia.
3. Robotic Surgery: Minimally invasive surgery using small (8mm) incisions and attached to robotic instruments (controlled by the surgeon) can be appropriate in some patients with epigastric hernia.
4. Open Surgery: Traditional open surgery may be necessary for larger or more complex hernias, involving an incision in the abdomen to access and repair the hernia with either sutures alone or in association with mesh.