Pathogenesis of the epigastric hernia.

Purpose: Epigastric herniation is a rather common condition with a reported prevalence up to 10 %. Only a minority is symptomatic, presumably the reason for the scarce literature on this subject. Epigastric hernias have specific characteristics for which several anatomical theories have been develop...

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Publicado en:Hernia Vol. 16; no. 6; pp. 627 - 634
Autores principales: Ponten JE, Somers KY, Nienhuijs SW, Ponten, J E H, Somers, K Y A, Nienhuijs, S W
Formato: review Journal Article
Publicado: Springer Nature Dec2012
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Dec2012
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      pub: Springer Nature
      place: New York, New York
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        2011789745
        10.1007/s10029-012-0964-8
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        atl: Pathogenesis of the epigastric hernia.
      aug:
        au:
          Ponten JE
          Somers KY
          Nienhuijs SW
          Ponten, J E H
          Somers, K Y A
          Nienhuijs, S W
        affil: Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
      sug:
        subj:
          Hernia, Abdominal Epidemiology
          Hernia, Abdominal Etiology
          Age Factors
          Hernia, Abdominal Pathology
          Human
          Incidence
          Prevalence
          Sex Factors
      ab: Purpose: Epigastric herniation is a rather common condition with a reported prevalence up to 10 %. Only a minority is symptomatic, presumably the reason for the scarce literature on this subject. Epigastric hernias have specific characteristics for which several anatomical theories have been developed. Whether these descriptions of pathological mechanisms still hold with regard to the characteristics of epigastric hernia is the subject of this review.Methods: A multi-database research was performed to reveal relevant literature by free text word and subject headings 'epigastric hernia', 'linea alba', 'midline' and 'abdominal wall'. Reviewed were studies on anatomical theories describing the pathological mechanism of epigastric herniation, incidence, prevalence and female-to-male ratio and possible explanatory factors.Results: Three different theories have been described of which two have not been confirmed by other studies. The attachment of the diaphragm causing extra tension in the epigastric region is the one still standing. Around 1.6-3.6 % of all abdominal hernias and 0.5-5 % of all operated abdominal hernias is an epigastric hernia. Epigastric hernias are 2-3 times more common in men, with a higher incidence in patients from 20 to 50 years. Some cadaver studies show an epigastric hernia rate of 0.5-10 %. These specific features of the epigastric hernias (the large asymptomatic proportion, male predominance, only above umbilical level) are discussed with regard to the general theories.Conclusions: The epigastric hernia is a very common condition, mostly asymptomatic. Together with general factors for hernia formation, the theory of extra tension in the epigastric region by the diaphragm is the most likely theory of epigastric hernia formation.
      pubtype: Academic Journal
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        review
        Journal Article
      ougenre: Article
    language: English
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