What is it?
A hernia is a weakness in the tummy wall. An epigastric hernia is a weak spot or gap above the tummy button. The area of the hernia gets swollen because organs within the tummy are pushing through the weak spot. It may get bigger or give pain. Sometimes there is more than one hernia. The hernia is not any fault of the parents.
The operation
Your child will have a general anaesthetic, and will be asleep for the whole operation. A cut is made into the skin above the tummy button. Whatever organs are pushing through the weak spot are placed back in the tummy and the weak spot or gap is closed with strong stitches. The cut in the skin is then closed up. Usually you can take your child home the same day.
Any alternatives
If you leave things as they are, the hernia will get bigger and more uncomfortable. Binding the hernia down or using trusses will not help. Keyhole operations are experimental, and leave a scar not much smaller than the one being planned.
If the hernia is not repaired, the greatest danger to the child is the abdominal organs getting trapped in the hernia. This usually happens after some excess physical activity and it can be very painful. Even worse, the organs that get trapped in the hernia can get strangulated, the blood supply to them can stop and they get necrotic (die). This serious condition is called an incarcerated hernia. If this happens the child must be taken to hospital urgently and an emergency operation will be needed to fix the problem. If your child has a hernia, you should be alert to this potential situation and seek medical advice urgently if you have any suspicions that your child is getting rather uncomfortable in or around the area of the hernia.
For these reasons it is very important to proceed with the hernia repair before your child experiences such problems.
Before the operation
Your child must have nothing to eat or drink for about six hours before the operation. This means not even a sip of water. Your child's stomach needs to be empty so that the anaesthetic can be administered safely. If your child has a cold in the week before admission to the hospital, please telephone the ward and let the ward sister know. The operation will usually need to be put off. Your child has to get over the cold before the operation can be done. By having an anaesthetic the cold could turn into a serious infection in the chest.
Sort out any tablets, medicines, inhalers that your child is using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, your child may be checked for past illnesses and may have special tests to make sure that he or she is well prepared and can have the operation as safely as possible. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You and your child will have the operation explained to you and you will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you and your child visit for an hour or two, a week or so before the operation for these checks.
After - in hospital
Your child will be sleepy after the operation and is likely to sleep for an hour or more afterwards. The drugs given for a general anaesthetic will make your child clumsy, slow and forgetful for about 24 hours. This happens even if your child feels quite all right. Do not leave your child on his or her own or let your child use anything sharp or dangerous. Your child will probably not notice any particular pains. If necessary your child can take a painkiller by mouth, such as paracetamol in liquid or tablet form. By the end of one week the wound should be virtually pain-free. There may be stitches or clips in the skin. Sometimes the wound is held together with the stitches under the skin that dissolve and don’t need to be removed. . There may be some swelling of the surrounding skin which improves in two to three days. This is expected and you should not worry about it.
After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so. You can wash your child but try to keep the wound area dry until the stitches or clips come out or for about a week if there only stitches under the skin. Baths or showers with ordinary soap and water are all right. Salt water is not necessary. Some hospitals leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.
After - at home
Your child may need frequent sleeps for a day or two. Although it is usually difficult to limit what he or she does, try to help your child avoid any excess physical activity for four to six weeks after the operation, particularly if he or she is over five years old. If your child goes to school he or she can return to lessons after about 10 days. Your child can restart any sport in four to six weeks.
Possible complications
As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs. The tests that your child will have before the operation will make sure that he or she can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Complications are rare and seldom serious. If you think that something is wrong let the doctors or the nurses know. There is often some swelling and even some redness around the wound. These usually settle in three or four days. Infection is a rare problem and settles down with antibiotics in a week or two. It is very rare for the hernia to form again. The risk or recurrence is less than 1 in 100. This is more common in children who have a wound infection after the operation or who don’t avoid any excess physical activity for the first four to six weeks.
General advice
These notes will help you and your child through the operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.
