An epigastric hernia, commonly occurring between the xiphoid process and umbilicus, involves the protrusion of extraperitoneal fat through a weakened linea alba, often affecting manual workers aged 30-45. Symptoms can range from asymptomatic to painful attacks during exertion, with treatment options including surgical intervention when necessary. Surgical procedures involve clearing herniated fat, closing the defect, and potentially using mesh reinforcement for larger hernias.

1. Epigastric
hernia
(synonym: fatty
hernia of the
linea alba)

2.  Anywhere between the xiphoid process and the
umbilicus, usually midway.
 Protrusion of extraperitoneal fat through the linea
alba- site where small blood vessels pierced the
linea alba(minority).
 More likely that the defect occurs as a result of a
weakened linea alba due to abnormal decussation
of the fibres of the aponeurosis.
 Common cause of ‘recurrence’ is failure to identify
a second defect at the time of original repair.

3.  A swelling the size of a pea(<1cm) -protrusion of
extraperitoneal fat only
 Enlarges, it drags a pouch of peritoneum after it
 The mouth of the hernia is rarely large to permit a
portion of hollow viscus to enter it;
 So, Either the sac is empty or it contains a small
portion of greater omentum.
 It is likely that an epigastric hernia is the direct result
of a sudden strain tearing the interlacing fibres of
the linea alba.

4.  The patients are often manual workers
between 30 and 45 years of age.

5. Clinical features
 Symptomless:
 A small fatty hernia of the linea alba can be felt more easily than it
can be seen and may be symptomless, discovered only in the
course of routine abdominal palpation. DDx: Lipoma
 Painful:
 Sometimes such a hernia gives rise to attacks of local pain, worse on
physical exertion, and tenderness to touch and light clothing.
 This may be because the fatty contents become nipped sufficiently
to produce partial strangulation.
 Referred pain:
 It is not uncommon to find that the patient, who may not have
noticed the hernia, complains of pain suggestive of a peptic ulcer.
 However, as the majority of these hernias are asymptomatic,
symptoms should not be ascribed to the hernia until any
gastrointestinal pathology has been excluded.

6. Treatment
 Very small – disappear(infarction)
 Small to moderate - If the hernia is giving
rise to symptoms, operation should be
undertaken.

7. Operation (open or lap)
 An adequate vertical or transverse incision is made over the
swelling, exposing the linea alba.
 The protruding extraperitoneal fat is cleared from the hernial
orifice by gauze dissection.
 If the pedicle passing through the linea alba is slender, it is
separated on all sides of the opening by blunt dissection.
 After ligating the pedicle, the small opening in the linea alba is
closed with non-absorbable sutures in adults and with
absorbable sutures in children.
 When a hernial sac is present, it is opened and any contents
reduced, after which the sac neck is transfixed and the sac
excised before repairing the linea alba.
 If smaller protrusions of fat are found above or below the
hernia, these should also be dealt with.
 If the hernia is large (defect greater than 4 cm diameter), the
repair should be reinforced with polypropylene mesh positioned
in the retromuscular plane