I Corsale1, E Palladino. 1. Istituto di Chirurgia Sperimentale, Seconda Università-Napoli.
Abstract
BACKGROUND: Epigastric hernias are 0.35-1.5% of abdominal hernias and 8% of midline ones. They are often of small dimensions (15-25 mm) but voluminous epigastric hernias (5-10 cm) may occur. In these cases the sac may contain epiploic appendages or viscera (ileum loops, stomach). 20% of epigastric hernias are multiple: for this reason we must consider the integrity of the whole linea alba. Ultrasound scan, showing a 100% sensibility towards this pathology, is extremely effective to achieve this aim. METHODS: We have reviewed our experience since 1989 analysing the clinical, diagnostical and therapeutical aspects and pointing out the not too distinct symptomatology of epigastric hernias, including those complicated by incarceration. We always carry out surgical correction of epigastric hernias in general anaesthesia and open the peritoneal sac in order to loosen possible adhesions. We have employed a properitoneal MESH (polypropylene) only in voluminous hernias. RESULTS: In a two years follow-up in 79% of patients, no recurrences have been observed. CONCLUSIONS: The surgical correction of epigastric hernias does not always need a prosthesis, but it may be a simple direct reconstruction as long as the suture is carried out in the correct direction depending on the dimensions of the hernial porta. On the other hand, recurring epigastric hernias and voluminous hernias, multiple or isolated, can be corrected with a polypropylene MESH placed in the properitoneal area.
BACKGROUND:Epigastric hernias are 0.35-1.5% of abdominal hernias and 8% of midline ones. They are often of small dimensions (15-25 mm) but voluminous epigastric hernias (5-10 cm) may occur. In these cases the sac may contain epiploic appendages or viscera (ileum loops, stomach). 20% of epigastric hernias are multiple: for this reason we must consider the integrity of the whole linea alba. Ultrasound scan, showing a 100% sensibility towards this pathology, is extremely effective to achieve this aim. METHODS: We have reviewed our experience since 1989 analysing the clinical, diagnostical and therapeutical aspects and pointing out the not too distinct symptomatology of epigastric hernias, including those complicated by incarceration. We always carry out surgical correction of epigastric hernias in general anaesthesia and open the peritoneal sac in order to loosen possible adhesions. We have employed a properitoneal MESH (polypropylene) only in voluminous hernias. RESULTS: In a two years follow-up in 79% of patients, no recurrences have been observed. CONCLUSIONS: The surgical correction of epigastric hernias does not always need a prosthesis, but it may be a simple direct reconstruction as long as the suture is carried out in the correct direction depending on the dimensions of the hernial porta. On the other hand, recurring epigastric hernias and voluminous hernias, multiple or isolated, can be corrected with a polypropylene MESH placed in the properitoneal area.