A hernia is a hole through a weakness in the abdominal wall.
At the start of trouble you may notice a lump or bulge appearing anywhere in the central, upper abdomen between the breastbone and the tummy button. This area is known as the ‘epigastrium’, hence the term ‘Epigastric Hernia’.
The bulge consists most usually only of fatty tissue but when large can contain gut. You may experience discomfort at first but it may become more painful when lifting heavy objects or coughing.
This hernia should not be confused with a large bulge running from the breastbone to the navel which can sometimes occur as a result of putting on weight and surgery is seldom recommended.
A weakness in the muscles of the abdominal wall cause this type of hernia. Other factors, which contribute to the development of epigastric hernias are straining, coughing, heavy work, sports, obesity etc.
An epigastric hernia can either be treated by a surgical operated or they can be treated more conservatively (without a surgical procedure).
Many patients will choose to have the hernia operated on due to discomfort, an increase in size or because the hernia has become unsightly.
If the hernia is left untreated then the weakness in the muscle wall could grow and in rare case could contain loops of the bowel. When this occurs you maybe unable push the hernia back and a blockage of the bowel may occur. This can also cause vomiting and abdominal pain.
If you experience these symptoms you should contact your doctor immediately as you may require an emergency operation.
If you chose to have an operation you will be asked to attend the pre-admission assessment clinic prior to admission to ensure you are fit for surgery, allowing time for the necessary pre-operative tests, which may include blood tests, cardiogram(ECG) and a chest x-ray.
Some risk factors could be eliminated or at least lessened. This may involve some effort on your part, for example losing weight or stopping smoking.
You will be admitted on the day of surgery unless there are any medical or technical reasons, which may require you to be admitted the day before.
Most patients go home on the operation day (day case), but some maybe be required to spend 1-2 nights in hospital.
Surgical repair can be carried out under general anaesthetic or local anaesthetic. The choice depends partly on which you prefer and partly on what your anaesthetist and surgeon think is best.
The incision is usually made in the abdominal wall overlying the site of the hernia. The pouch (hernia sac) is first dealt with and the contents returned back into the abdomen. Then the weakness in the abdominal wall is strengthened. This is done using either permanent stitches or a patch of nylon mesh that is stitched in place; the wound is then closed using an invisible dissolvable stitch and covered with a waterproof dressing.
These will be explained and discussed with you in detail when the surgeon asks you to sign the consent form prior to the procedure being undertaken.
You will commence fluids as soon as you are able, if tolerating fluids you will progress to a light diet.
Abdominal wound pain/discomfort is to be expected after the operation.
Therefore pain relief consisting of injections or tablets may be required in the first 24-48 hours.
If you feel sick after the operation, please tell the nurse looking after you, as she/he will give you an injection to help with this.
The wound will be sealed within 5 days after which time the dressing may be removed and you may take a bath or a shower.
It is important to avoid constipation and straining when you go to the toilet.
Take plenty of fibre in your diet and drink plenty of fluids. If you find you continue having difficulty with your bowels on your return seek advice from your GP.
You may resume sexual relations as soon as this feels comfortable to do so.
After the operation activity is encouraged. You should avoid suddenly putting extra strain on the wound for at least 4 weeks. However, it is essential you progressively increase your activity day by day.
It is wise not to drive for at least 1 week; some people feel they need a little longer. Usually if you can get in and out of the bath without any discomfort and/or assistance you can consider driving and over time, increase the distance of your trips. However, please check with your insurance company, as some policies carry restrictions that vary with individual companies.
If you require a certificate for work, please ask a member of staff before discharge. If your work does not involve heavy lifting or violent exercise, then return to work could be as soon as 2-3 weeks. If it does, then it is safer to wait for a further 2-4 weeks. If this advice is not heeded, the repair could give-way and the hernia will recur.
Some swelling or bruising around the wound site is not unusual and there will be some discomfort and tenderness where the incision has been made. In the period following you operation you should seek medical advice if you notice any of the following problems: