Surgical Repair of Epigastic Hernia or Fatty Hernia of Linea Alba

Surgical Repair of Epigastic Hernia or Fatty Hernia of  Linea Alba

Indication- Symptomatic Epigastric Hernia

Anaesthesia- Epidural/General

Position- Supine

Incision- Transeverse incision through the hernia

Procedure

• Hernial sac identified and dissected out
• Open the sac and inspect the contents
• Usual content is pre peritoneal fat or omentum
• Delineate the defect in the Linea alba
• Reduce the contents back into the peritoneal cavity
• Abnormal or thickened part of omentum can be excised making sure that no bowel is injured- Beware of transverse colon or small intestine which can get entangled within!
• Peritoneum is closed
• Repair of the defect can be done with No 1 polypropelene ( Primary closure  and Darning) or with Pre peritoneal or On lay(Over the Rectus sheath)  mesh repair (Using a polypropelene mesh)

Note- The usual symptoms of epigastric hernia is upper abdominal pain with or without visible swelling.

Hence this pain can be mistaken for Peptic ulcer disease.

Differential Diagnosis- Parietal (Abdominal ) wall Lipoma

Special feature : Unlike other abdominal wall hernias, an epigastric hernia does not show any impulse on coughing as the contents are pre peritoneal fat or entangled omentum.