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.
