Name of the Procedure:

Repair of Epigastric Hernia (eg, preperitoneal fat); Incarcerated or Strangulated

Summary

Epigastric hernia repair is a surgical procedure to correct a hernia located in the upper abdominal wall near the sternum. It involves the reduction of preperitoneal fat or tissue that has protruded through the abdominal wall and is either incarcerated (trapped) or strangulated (cut off from blood supply).

Purpose

This procedure addresses epigastric hernias that cause pain, discomfort, or more serious complications due to trapped or cut-off tissues. The goal is to relieve symptoms, prevent complications, and restore the normal anatomy of the abdominal wall.

Indications

• Persistent pain or swelling in the upper abdomen.
• Symptoms of bowel obstruction or strangulation (severe pain, nausea, vomiting).
• Diagnosis of an incarcerated or strangulated hernia through clinical assessment or imaging.
• Patients experiencing complications or at high risk of complications from an untreated hernia.

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Stopping certain medications, such as blood thinners, as instructed by the healthcare provider.
• Undergoing preoperative diagnostic tests like blood tests or imaging studies (e.g., ultrasound or CT scan).

Procedure Description

1. The patient is administered anesthesia, typically general anesthesia.
2. A small incision is made near the location of the hernia.
3. The herniated tissue is carefully reduced back into the abdominal cavity.
4. Any necrotic or damaged tissue is removed if necessary.
5. The defect in the abdominal wall is repaired, often using sutures or a mesh to reinforce the area.
6. The incision is closed with sutures or staples and covered with a sterile dressing.

Duration

The procedure typically takes about 1-2 hours, depending on the complexity of the hernia and the specific techniques used.

Setting

The surgery is usually performed in a hospital or a specialized surgical center.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurse
• Operating room technician

Risks and Complications

• Risk of infection at the surgical site.
• Bleeding or hematoma formation.
• Recurrence of the hernia.
• Injury to nearby structures (bowel, blood vessels).
• Anesthesia-related risks.
• Prolonged pain or discomfort after surgery.

Benefits

• Relief from pain and discomfort related to the hernia.
• Prevention of serious complications such as strangulation.
• Improved quality of life and ability to perform daily activities.

Recovery

• Post-procedure monitoring in the recovery area.
• Pain management with prescribed medications.
• Instructions to avoid heavy lifting or strenuous activities for several weeks.
• Follow-up appointments to check the healing process.
• Gradual return to normal activities as advised by the healthcare provider.

Alternatives

• Nonsurgical management (watchful waiting) for asymptomatic or minimally symptomatic hernias.
• Laparoscopic hernia repair, which is minimally invasive.
• Pros of alternatives: Less invasive options might have shorter recovery times.
• Cons of alternatives: Risk of the hernia becoming symptomatic or complicated over time.

Patient Experience

During the procedure, the patient is under anesthesia and should not feel any pain. Postoperatively, patients may experience mild to moderate pain, swelling, and bruising at the incision site, which is manageable with medication. Full recovery usually takes a few weeks, during which activity levels should be gradually increased as tolerated.