Epigastric Hernia Treatment in Turkey

What is an Epigastric Hernia?

An epigastric hernia is a type of abdominal wall hernia that develops through a weakness or defect in the upper midline of the abdominal wall, between the lower end of the breastbone and the umbilicus. The hernia may contain preperitoneal fat and, less commonly, abdominal organs or bowel when the defect is larger. It may appear as a small bulge that becomes more noticeable when you stand, cough, strain, or exercise. Some epigastric hernias cause no symptoms, while others can lead to pain, tenderness, pressure, or complications such as incarceration or strangulation.

What is the Importance of Timely Treatment?

Timely evaluation helps determine the size and location of the abdominal wall defect, whether the hernia is reducible, and whether symptoms or complications are present. Small, asymptomatic epigastric hernias may be monitored, while painful, enlarging, or functionally troublesome hernias may require elective repair. Sudden severe pain, vomiting, abdominal distension, or a firm hernia that cannot be pushed back may indicate incarceration or strangulation and requires urgent medical assessment.

What are the Common Symptoms of an Epigastric Hernia?

• A visible or palpable lump in the upper middle abdomen
• A bulge that becomes more prominent while standing, coughing, or straining
• Pain or tenderness at the hernia site
• A feeling of pressure or pulling in the upper abdomen
• Discomfort during lifting, exercise, or other physical activity
• Increasing size of the abdominal bulge
• Local sensitivity around the hernia
• Cosmetic concerns related to the abdominal contour
• Nausea or vomiting when complications occur
• Severe abdominal pain or inability to reduce the hernia when incarceration or strangulation develops

Causes and Risk Factors of Epigastric Hernia

Causes

• A congenital or acquired weakness in the upper abdominal wall
• Separation or weakness of the fibres of the linea alba
• Increased intra-abdominal pressure
• Repeated coughing or straining
• Chronic constipation and straining during bowel movements
• Heavy physical work or repeated lifting
• Certain abdominal wall structural abnormalities
• Previous abdominal trauma or surgery in selected cases

Risk Factors

• Obesity or increased abdominal pressure
• Chronic cough
• Chronic constipation
• Repeated heavy lifting or strenuous physical activity
• Pregnancy
• Multiple pregnancies
• Conditions associated with increased intra-abdominal pressure
• Connective-tissue disorders or impaired abdominal wall strength
• Previous abdominal surgery or trauma in selected patients
• Increasing age and age-related changes in tissue strength

Latest Research and Technologies in the Treatment of Epigastric Hernia in Turkey

• Current treatment focuses on selecting the appropriate repair based on the hernia's size, symptoms, anatomy, and the patient's overall health. Ultrasound can identify small or uncertain abdominal wall defects, while CT helps in selected complex cases or when detailed preoperative planning is needed. Open repair with preperitoneal mesh is an established approach for many symptomatic epigastric hernias. Consider laparoscopic repair for larger defects or patients at increased risk of wound complications. Robotic-assisted repair may be available at selected centres, but it is not necessary for every patient, and its suitability depends on the clinical situation and the surgeon's expertise. Availability of these options varies between hospitals in Turkey.