Epigastric Hernia

What is an epigastric hernia?

Down the middle of your belly, a strip of tough tissue called the linea alba joins the two rectus muscles. An epigastric hernia is a hole in that strip somewhere between the breastbone and the belly button. Fat from inside the belly pushes through the hole and makes a lump you can see or feel. Sometimes there is more than one.

Most epigastric hernias are small, under 2 cm, about the size of a pea or a grape. Even a small one can be tender. I also see large ones from time to time.

Is it an epigastric hernia or a diastasis?

A diastasis is the most common thing mistaken for an epigastric hernia. In a diastasis, the two rectus muscles have drifted apart and the middle strip is stretched thin, but there is no hole. It shows up as a long ridge down the middle when you sit up and goes away when you relax. An epigastric hernia is one lump in one spot, and it is often there when you stand, even at rest.

The two can happen together. See the drawings and a side by side table in diastasis or epigastric hernia?

Can I wait to fix my epigastric hernia?

If your hernia does not bother you, waiting can be a safe choice. The only way to know for sure if watchful waiting is appropriate for you is to speak to Dr. Rodriguez or to your surgeon.

A hernia will never heal on its own. Surgery is the only way to fix it. If your hernia is getting bigger, I recommend fixing it sooner, because a smaller hernia is easier to repair and to recover from.

How I repair an epigastric hernia

Most epigastric hernias are small, and the repair is quick, about 30 minutes. Small ones can be hard to find once you are lying flat and asleep, so I mark the spot before surgery.

1. Before surgeryI will ask you to show me the bulge, and I will draw a small incision line right over the top of it.
2. In the operating roomI use ultrasound to find the hole in the fascia, the strong layer of the belly wall.
3. The repairThrough that small incision, the hernia is reduced and the hole is repaired.

Larger epigastric hernias

If your epigastric hernia is larger, I use the same rules I use for umbilical hernias to decide between robotic and open repair, and whether to use mesh. The robotic setup is usually the same as for an umbilical hernia: four small incisions on your left side.

• Hole under 1 cm: if there is only a minimal diastasis, stitches alone may be enough, with a robotic mesh repair if you have a BMI over 30, smoke, have diabetes (an A1C usually over 7%), do heavy lifting, or have a physical job.
• Hole 1 to 4 cm: we decide together. I recommend the robotic repair: I close the hole, then lay the mesh over it with 2 cm of overlap.
• Hole over 4 cm: I treat it like an incisional hernia. I close the hole, and the mesh goes behind the muscle, with at least 5 cm of overlap.

These size groups follow the European Hernia Society and Americas Hernia Society guideline for umbilical and epigastric hernias (Henriksen et al., Br J Surg 2020;107:171-190, doi:10.1002/bjs.11489). See the size chart.

If you also have a diastasis

An epigastric hernia can come with a diastasis. If you have both, I address the diastasis in the same operation.

What is recovery like?

• Most patients go home the same day.
• Nothing over 10 to 15 pounds until your 2 week visit, when we reassess. A gallon of milk weighs a little over 8 pounds, a good everyday guide.
• Shower the day of surgery and pat the incision dry. No soaking in a tub, pool, or hot tub for 4 weeks.
• Absorbable stitches under the skin and waterproof skin glue on top. No staples to remove.

Recovery and getting back to life →