Epigastric Hernia Repair

Procedure Snapshot

• Indication: Symptomatic fascial defect between umbilicus and xiphoid.
• Expected duration: ___
• Special instruments: Mesh, suture passer, retractors.

Step Workflow

1. Transverse incision over defect.
2. Dissect fascia; reduce preperitoneal fat.
3. Close primarily (< 2 cm) or place mesh.
4. Layered closure.

Key Pimp Questions

• Q: Contents of sac? Preperitoneal fat.
• Q: Mesh indication? > 2 cm defect (PMID 31648391).
• Q: Recurrence rate? ___ (PMID 31648391).

Critical Anatomy

• Landmarks: Linea alba, rectus sheath.
• Danger zones: Epigastric vessels.

Informed Consent Highlights

• Risks:
  • Recurrence ___ (PMID 31648391)
  • Seroma ___
  • Mesh infection ___

Post-op Considerations

• Binder optional.
• Avoid heavy lifting × 2 weeks.

References

• Chassin’s, Hernia section.
• Clinical Scenarios, Abdominal wall.
• Venclauskas 2019 (PMID 31648391).