Pathogenesis of the epigastric hernia

Area of Science:

• Abdominal Wall Surgery
• Hernia Research
• Anatomical Pathology

Background:

• Epigastric herniation is a prevalent condition, affecting up to 10% of the population.
• A significant majority of epigastric hernias are asymptomatic, contributing to limited research.
• Existing anatomical theories on epigastric hernia formation require re-evaluation in light of observed characteristics.

Purpose of the Study:

• To review existing literature on epigastric hernias.
• To assess the validity of current anatomical theories regarding epigastric hernia pathogenesis.
• To explore incidence, prevalence, and demographic factors associated with epigastric hernias.

Main Methods:

• A comprehensive multi-database literature search was conducted.
• Keywords included 'epigastric hernia', 'linea alba', 'midline', and 'abdominal wall'.
• Studies focusing on anatomical theories, incidence, prevalence, and sex ratio were reviewed.

Main Results:

• Three distinct theories of epigastric hernia formation were identified; two lacked empirical support.
• The theory involving diaphragmatic tension remains the most plausible explanation.
• Epigastric hernias constitute 1.6-3.6% of all abdominal hernias and 0.5-5% of operated hernias, with a 2-3:1 male predominance, primarily in individuals aged 20-50.

Conclusions:

• Epigastric hernias are a common, predominantly asymptomatic condition.
• The theory of increased epigastric tension, influenced by the diaphragm, is the most likely cause, alongside general hernia formation factors.