What is an epigastric hernia?
An epigastric hernia is an opening or weakness in the fibrous tissue of the abdomen between the breast bone and the belly button. In the pediatric population epigastric hernias are congenital conditions (children are born with them) caused by incomplete closure of the fibrous tissue of the abdomen during development. Often they are noticed because a small piece of intra-abdominal fat becomes trapped, or incarcerated, in the hernia. When your child cries, stools, or bears down, a small bump will push out somewhere along the center of the abdomen. Usually the bump is filled with fluid or fat. As soon as the child relaxes, the bump will sink back into the abdomen. While epigastric hernias may be asymptomatic, sometimes they can be quite tender, and the child may complain of pain at the site.
Treatment options depend on the age of the child and the size of the problem. Unlike umbilical (belly button) hernias which can often close without surgery over a period of years, epigastric hernias rarely resolve on their own. For small problems with infants, the doctor might take a wait and see approach. As the child grows, the abdominal wall matures and strengthens, which may eventually resolve the hernia. Toddlers tolerate surgery better than infants. Serious complications are very rare. Small defects typically entrap fat and can become red and painful. Larger defects can trap intestines in the protrusion, leading to intestinal blockage or damage. This is potentially a very serious complication because this can compromise blood flow to the intestines. The only way to fix this is emergency surgery.
What will happen in the hospital?
Surgery is typically scheduled on an elective basis. A small incision is made over the defect and the surgeon pushes the protruding fat back in or removes it and then stitches up the hernia. If it is large, the surgeon pushes back the protruding section of bowel or stomach and then patches the hernia.
When will my child be discharged?
Usually, once your child is awake, able to tolerate some food or liquids and their pain is well controlled they will be discharged from the PACU (recovery room). The operation is usually done as a day surgery but occasionally an overnight stay may be needed.
What will be my child's recovery?
Most children do not have severe pain after an epigastric hernia repair. Most often over-the-counter pain relievers such as Children's Tylenol or Children's Advil are adequate for pain control. The steri-strips should remain in place for at least ten days after the surgery. Your child may shower but should not tub bathe or swim for two weeks until incisions have healed. Your child should avoid vigorous physical activity for 2 weeks. We will see you in the pediatric surgery clinic 2 weeks after the operation for a postoperative visit.
What should I be looking out for after the operation?
In the first two weeks after surgery it is important to monitor for signs or symptoms of infection such as redness, swelling around the surgical site or fever. As with all operative procedures, the most common complication is potential for infection of the surgical site. There may be a persistent palpable bulge after surgery, this is bulge is cause by the suture used to close the defect or by a small non-infected collection of fluid at the operation site. This gradually goes away as the suture begins to dissolve.