It has been determined that you have an EPIGASTRIC HERNIA (photo). Because of your current symptoms and/or findings, and the potential for persistent pain or complications arising from the presence of this hernia, surgical repair has been recommended. An Epigastric Hernia occurs due to a weakness, gap or opening in the muscles or tendons of the upper abdominal wall, on a line between the breast bone and the navel or umbilicus. This results in a bulge of intra-abdominal contents and/or pain or discomfort. This pain and discomfort is the result of nerves and tissue in this area being irritated or stretched as the surrounding tissue is also stretched. If these hernias enlarge, intestine may become trapped within the hernia leading to intestinal blockage or damage (Strangulation or Incarceration). This is considered a surgical emergency.
Surgery involves repair of the area of weakness and return of the abdominal contents back into their normal position. We will most often utilize a plastic screen or mesh (made from non-reactive polypropylene, Gortex®, or at times both) to safely reinforce the area in repairing the overwhelming majority of Epigastric Hernias (both primary and recurrent hernias). The decision on which type, size and specific manufacturer of mesh to be utilized will be made by your surgeon at the time of surgery. Surgical repair of hernias is called a Herniorrhaphy. Since muscle is not cut nor sewn together under tension with our advanced method of repair, this technique is called a TENSION FREE REPAIR TECHNIQUE.
Most often in adults, small to moderate sized Epigastric Hernia repair surgery will be performed under local anesthesia. What this means is that although you are somewhat sedated by our Department of Anesthesia, you will not be put to sleep. Rather, the area will be numbed with the use of several injections of Novocaine-like medication. You will be kept relaxed, comfortable and pain-free during the short procedure. After surgery, you will be observed in our ambulatory surgery center where you will be active and able to walk, and offered a light snack.
Patients with small or moderate size, non-complex Epigastric Hernia repairs are discharged on the day of surgery Safely and Comfortably. A prescription for pain medication will be provided, or you will be instructed in taking over-the counter pain medication.
We have extensive experience in the repair of Epigastric Hernias, hundreds of such repairs annually (and nearly 1000 hernia repairs overall annually). The surgeons of the North Penn Hernia Institute have received special training in hernia repair, and truly "Specialize" in this field of surgery. This permits us to provide you, our patients with the safest, most advanced and most effective hernia repair available. As such, our success rate is extremely high, equal to or better than the national average. Additionally, our complication rate is extremely low, again comparable to or below the rates which are reported nationally.
So that you may be fully informed, as required by Pennsylvania law, we have listed below the possible major complications of hernia repairs, including Epigastric Hernia surgery, based on national averages. Again, we believe our success is better and our complication rate lower than these averages, but they are listed for your information.
All surgical incisions may be associated with some local numbness, as virtually invisible nerves within the skin and lower layers are divided during the initial incision process. Most of this will be temporary, however a very small area of residual numbness around the incision may persist. This is generally well tolerated, minimally noticeable and creates no functional problems. This mild numbness may be located in a small area of skin at or below the incision.
- Recurrence of the Hernia...................About 1/2% (1 in 200 patients)
- Infection of Incision...........................................Less than 1%
- Bleeding (controlled in OR)..............................Less than 1%
- Swelling and black/blue......................................................About 5% (temporary)
- Injury to intestine or other intra-abdominal organs..........Less than 1 in 2000
- Numbness or Chronic Incisional Pain**..............................1-2%
(*Generally mild, non-debilitating and resolves over time)
Source:HERNIA, Nyhus, Condon 5rd Ed. 2001
Chronic incisional pain or discomfort occurs in approximately 1-2% of all surgical procedures including all hernia repair techniques. With our method, because muscle is neither cut nor pulled together under undue tension, this discomfort is generally mild and usually temporary, lasting 2-3 months or less. More chronic pain is less likely. Severe and long lasting pain at the area of the incision can occur, but is extremely rare (less than 1/2%).
If your hernia is being repaired for the second or more time, the chance of recurrence and other complications listed above may be only slightly higher. We also have extensive experience in the repair of multi-recurrent and large hernias which have been specifically referred to us. We will take every available precaution and use contemporary technique to reduce these complications for you and assure you with an effective repair.
While the over-whelming majority of Epigastric hernias are both safely and effectively repaired using just local anesthesia and mild sedation (over 95% of our patients here at NPHI), on extremely rare occasions, because of hernia complexity, multiple recurrence, extreme obesity and even patient comfort, conversion to a safe, light form of mild general anesthesia under the supervision of a Board Certified Anesthesiologist may be required. This need can at times be anticipated on initial physical examination. Our Anesthesiologist, therefore, must reserve the right to such a conversion during surgery if in their opinion, patient safety so dictates.
According to Law, I attest that I have read and understand the three (3) pages presented here, and have been informed as to the complications associated with Epigastric Hernia Repair. I understand the nature of my problem, based on the discussion with my physicians and the above information. Additional questions have been answered and I agree to the surgery as planned.