All about Epigastric Hernias

When surgery is performed to repair an epigastric hernia, and you suffer injuries due to a defective mesh, you may be entitled to compensatory damages.

Epigastric hernias, like umbilical hernias, are typically present from birth, although they can become more severe over time. They occur when the abdominal muscles between the belly button and the chest are weak in a particular area. Since the stomach muscles usually hold the organs and tissue within the body in place, this weakness can allow these tissues to move through the hole in the muscle. In most cases, epigastric hernias do not put a patient in immediate danger; however, they require surgery to prevent long-term complications.

If you are considering treatment for yourself or for your child for an epigastric hernia, you may be wondering what your options are. While surgery is necessary in order to repair this type of hernia, your doctor has a responsibility to choose when and how the operation is performed to ensure the best possible outcome.

Hernia mesh3
Epigastric hernias, like umbilical hernias, are typically present from birth, although they can become more severe over time.

1. What is an epigastric hernia?

Both children and adults can suffer from an epigastric hernia, but the conditions are slightly different.

1.1 Children

Since epigastric hernias are present at birth, they are usually diagnosed quickly. They may be diagnosed by a physician upon the initial exam of an infant, or they may become visible to the parent when the child is

  • Crying
  • Passing a bowel movement
  • Bending over or sitting up
  • Performing other actions which engage the abdominal muscles

During these actions, you might see a lump protrude from the stomach above the belly button. The lump recedes once the child returns to a neutral position. Often, the only symptom of an epigastric hernia in children is mild to moderate pain.

1.2 Adults

It is not uncommon for adults to be diagnosed with epigastric hernias that were not caught earlier in life. Men are 2 to 3 times more likely to develop epigastric hernias within their lifetime than women are. 1 The hernia can become more problematic due to

  • Obesity
  • Strain on the abdominal muscles from lifting weights or heavy objects
  • Muscle weakness from surgery or inactivity

One or more of these factors can cause a hernia to become an increasing issue for the patient. When tissue is pushed through the hole in the abdominal wall, the muscles contracting around it pinch the fat or organ painfully.

2. What are the complications?

In most cases, the hernia can be repaired before major complications occur. Unfortunately, on occasion, the epigastric hernia can become

  1. Incarcerated: when the tissue is stuck in the “out” position and does not recede back inside the abdominal wall, or
  2. Strangulated: when the incarcerated tissue is twisted or caught in such a way that blood cannot flow to the herniated area.

Strangulated hernias are a serious condition, calling for immediate treatment in order to avoid permanent damage to the area. Severe and continuous pain associated with a tender and hard lump in the abdomen that does not go away may signal an incarcerated or strangulated hernia.

3. When should you seek treatment?

Any time you or your child experience pain associated with a bulge in the stomach, a hernia may be present and medical counsel is advised. Unlike some other hernias, epigastric hernias will not resolve themselves without surgical intervention.

In cases involving children, a doctor may advise the parents to wait until the child is older so that he or she can tolerate the surgery. Or, a doctor may advise immediate surgery in order to prevent future complications.

In adults, an operation is almost always recommended as soon as possible, usually within a couple of months.

4. What are the surgical options?

There are two major types of surgery performed on hernias, including epigastric hernias. These are,

Herniorrhaphy or tissue repair: a traditional open surgery in which the surgeon

  • makes a cut directly over the hernial sac
  • removes the tissue or pushes it back into the body, and
  • stiches the muscles of the abdominal wall together with surgical sutures.

Hernioplasty or mesh repair: a more recently developed type of open surgery in which the surgeon

  • makes a cut directly over the hernial sac
  • removes or reinserts the tissue from the hernia, and
  • uses synthetic mesh to repair the hole in the abdominal wall.

Either of these surgeries can be performed, under certain conditions, laparoscopically. In laparoscopic surgery, four incisions are made around the hernia. Then, a fiber optic light cable and small surgical instruments are inserted into the body so that the physician can remove the hernia from the inside.

If your surgeon chooses to utilize mesh to repair your hernia, there are options. There is no standard mesh used for hernia repairs, and each one comes with its own track record of known complications and benefits. Therefore, your physician should be ready to explain the choice to use one type of mesh over another. 2

5. Are there any complications associated with surgery?

Although hernia repair surgeries are performed regularly, like all surgeries, they come with certain risks. 3 Patients who have undergone epigastric hernia repair may experience

  • Scarring, pain, infection, bleeding, or blood clots (common to any surgery)
  • Injury to tissue or structures within the abdomen such as intestines, blood vessels, or nerves
  • Recurrence of the hernia in up to 10% of patients.

In addition, patients may experience complications associated with the synthetic mesh used in some surgeries to repair epigastric hernias. 4 Such complications include

  • Migration of mesh from original location
  • Tears in the tissue
  • Mesh failing to hold
  • Preventable infections from the mesh
  • Bowel perforation and/or obstruction
  • Development of seroma (pocket of fluid) around mesh
  • Long term, chronic pain.

Complications arising from the use of mesh in hernia repairs can be serious and life-threatening. While some of these complications may be unavoidable, defective products can contribute to or cause pain, injury, and death.

6. When should you seek advice from a medical malpractice attorney?

If you have undergone surgery for an epigastric hernia and mesh was used to repair your abdominal wall, you may be experiencing unexpected complications. A medical malpractice attorney can evaluate your case and determine whether or not the medical device used in your procedure was defective.

As a surgical patient, you have the right to know about the complications and documented risks associated with your procedure. If you have been injured by a negligent physician or a defective product, a personal injury lawyer can help you take action.

References:

  1. University Surgeons. Epigastric Hernia Repair.
  2. Basile, Francesco, Antonio Biondi, and Marcello Donati. Surgical approach to abdominal wall defects: history and new trends. International Journal of Surgery. Dec, 2015; 11(1): 20-23.
  3. National Health Service. Epigastric Hernia Repair (adult).
  4. US Food and Drug Administration. Hernia Surgical Mesh Implants.

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