Epigastric Hernia Care

An epigastric hernia is a bulging of tissue or fat through an opening in the belly between the breastbone (chest) and the belly button. It happens when the fibrous tissue of the belly does not close all the way during development. It is often found during bathing or by a doctor during a well-baby visit.

Most children will appear to be comfortable and behave normally. When your child cries, has a bowel movement, or bears down a small lump will push out somewhere along the center of the belly between the breastbone and belly button. If the bulge comes on suddenly, your child may become cranky, cry out in pain, or not want to eat. As soon they relax, the lump will usually sink back into the belly. In some cases, it appears to be there all the time. This is OK if it isn’t causing any pain or other problems.

This type of hernia will not close on its own and must be repaired with surgery. This is done within a few months after finding it or sooner if your child is in pain. If not repaired, the hernia may get bigger or become painful.

Very rarely, the hernia can get stuck, which is called “incarcerated.” This means a piece of tissue or fat can slip through the opening and become twisted or caught there. This may stop the blood supply to these tissues which causes the pain. Your child may have sudden pain and you may see or feel a tender hard lump between the belly button and breastbone. If your child has these signs and you are not able to comfort them, call your doctor right away.

This is an outpatient surgery, which means your child will go home the same day.

We will give your child general anesthesia for this procedure, so they will be fully asleep. General anesthesia can be liquid medicine in an IV (intravenous or into a vein) tube or a gas your child will breathe in.

A small cut (incision) is made in the abdomen just over the hernia. The hernia sac may be removed or pushed back in, and fibrous tissue layers are stitched closed with dissolvable stitches. The outer skin is then closed with skin glue (Dermabond), or special tapes called Steri-Strips.

• The incision or surgery site will be closed with dissolvable stitches.
  You won’t see any stitches on the outside skin.
• Dermabond (skin glue) or Steri-Strips (small pieces of white tape) are used to cover the incision. This will usually flake or peel off on its own within 10 to 14 days.
• A little blood from the incision is normal.
• It is OK to shower 24 hours after surgery.
• No tub bathing or swimming for 1 week after surgery.

We partner with you and your child to prevent and relieve pain as completely as possible. You know your child best. No matter the level of your child’s pain, believe they are hurting and respond right away. After surgery your child is likely to have some pain and discomfort. In addition to medicine prescribed for pain, we will work with you to create a plan that encourages coping activities to treat pain and provide support. Help your child get better, faster with good pain management.

Your child should drink plenty of liquids and eat light meals after surgery. The next day, they can eat what they usually eat, if they feel well enough.

Some school-aged children may need to stay home to rest 1 day after surgery. If they feel well enough, they can return to school after that.

If your child is 10 years or younger:

• There are no restrictions. Your child can be as active as they can tolerate. 

If your child is 11 years or older:

• No lifting more than 15 pounds (7kg), sit-ups, or excess use of abdominal muscles for 3 weeks.
• No competitive sports or PE (physical education or gym) class for 1 week. 
• It is OK for your child to run or ride a bike as comfort allows.

You will get a follow-up phone call from the general surgery nurse within 1 week of your child’s surgery.

Please call us if your child develops any of the following symptoms or if you have questions at 206-987-2794, option 4 for clinic nurse.

Evenings or weekends, call 206-987-2000 and ask for the general surgeon on call.

Warning signs to call:

• Fever higher than 101.5° F (38.6° C) for more than 24 hours
• Redness, swelling or discharge (fluid) from the wound
• Rapid swelling or bleeding from the surgery site
• Severe, constant pain at the surgery site not controlled by the medicine prescribed
• Throwing up (vomiting) 4 or more times in 12 hours
• Cannot pee for a span of 8 hours after surgery
• Vomiting