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Epigastric Hernia Surgery

In Ahmedabad · Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad

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You have a small lump in the middle of your upper tummy, somewhere between the navel and the breastbone. It may be tender, it may ache after a meal or a long day, and it may be hard to see unless you tense your stomach. That is the usual story of an epigastric hernia. It is often small, yet it can hurt more than its size suggests. This page explains how Dr Harsh Shah confirms that the lump is a hernia, how he looks for a second gap, which repair he advises, and when he advises waiting.

In short: an epigastric hernia is a small gap in the midline above the navel. It does not heal by itself. Most are repaired through a small cut with a mesh.

Dr Harsh Shah repairs hernias of the tummy wall at Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad. He trained in surgery at Maulana Azad Medical College, Delhi, and in surgical gastroenterology at GB Pant Hospital, Delhi. He has 18 years of experience. He repairs epigastric hernias both by open surgery and laparoscopically, and he picks the route for each patient. For every repair he records the size of each gap, the layer used and the mesh placed, so that anyone who examines you later knows exactly what was done.

Dr Harsh Shah, epigastric hernia surgeon, Ahmedabad

Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Hernia Surgeon
· Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
★★★★★ 4.9 · 200+ Google reviews

Last updated: 18 October 2026 · Written and medically reviewed by Dr Harsh Shah

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What an epigastric hernia is

An epigastric hernia is a gap in the tough midline strip between the navel and the breastbone. A small plug of fat pushes through it and forms a lump.

The two long muscles at the front of your tummy are joined in the middle by a strip of tough tissue. Above the navel this strip is made of fibres that cross over each other. Small gaps can form where the fibres part. In some people the gap is there from birth and widens later. In others it opens after years of strain.

Through the gap, a small plug of fat from just inside the tummy wall pushes out. Bowel comes through less often, because most of these gaps are narrow. That narrow neck is also why the lump can hurt. The fat gets pinched each time the muscles tighten.

Things that raise the pressure inside the tummy make the gap more likely. These include extra weight around the waist, pregnancy, a long cough, heavy work and straining on the toilet. Men are affected more often than women, and the hernia is most often found between the ages of twenty and fifty.

Epigastric hernias often come in more than one. Up to one in five people has a second gap along the same line. They also often sit on top of a widened midline, called diastasis recti. Both facts change the plan, so both are looked for before surgery.

Is the lump really a hernia?

Not always. A fatty lump under the skin can look the same. Examination, and an ultrasound when needed, tell them apart and check for other gaps.

A soft lump in the upper tummy has a short list of causes. The commonest look-alike is a lipoma, which is a harmless lump of fat lying under the skin and not passing through the muscle. Others are a widened midline that bulges along its whole length, and a hernia in an old operation scar.

Dr Harsh Shah examines you standing and lying, and asks you to lift your head and shoulders off the couch. A hernia often pops out or becomes tender when the muscles tighten. A lipoma moves freely over the muscle. If the answer is not clear, or if you carry some weight, an ultrasound settles it. It measures the gap, shows what is inside it, and checks the full midline for a second gap. There is a fuller note on a lump above the belly button.

Pain in the upper tummy also has causes that have nothing to do with the wall. Acid, gallstones and stomach ulcers can all ache in the same place. If your pain does not match the lump, these are checked first, so that the hernia repair is not blamed for pain it cannot fix.

How the gap decides the repair

The width of the gap, the number of gaps and any midline widening decide the repair. A single small gap is repaired open. Several gaps are usually repaired laparoscopically.

What is foundUsual repairMeshCutWho it suits
One gap under about 1 cmOpen suture repairUsually noneOne small cut over the lumpSlim patients with a single tiny gap
One gap about 1 to 4 cmOpen mesh repairFlat mesh placed behind the muscleOne cut over the lump, about 3 to 5 cmMost adults with a single gap
Several gaps, a gap over about 4 cm, or a gap with diastasisLaparoscopic mesh repairLarger mesh covering the full midlineThree small cuts on the side of the tummySeveral gaps, heavier patients, a widened midline, repeat hernias

Joint European and American hernia guidance from 2019 supports this approach. A mesh is advised for most gaps of one centimetre or more, because stitches alone come apart more often. The bands above are a guide. Your weight, health and past operations are weighed with them.

The repairs, step by step

Every repair frees the fat, pushes it back and closes the gap. The difference is whether a mesh is added, and whether the surgeon works from outside or inside the tummy.

Open suture repair. A small cut is made over the lump. The plug of fat is freed and either pushed back or removed. The gap is closed with strong, slowly dissolving stitches. This suits a single tiny gap in a slim person.

Open mesh repair. The cut is the same, sometimes a little longer. After the fat is dealt with, a space is opened behind the muscle. A flat mesh is laid in that space so that it overlaps the gap on every side. The gap is closed over it. Most patients go home the same day or the next morning.

Laparoscopic mesh repair. The repair is done through three small cuts on one side of the tummy. The camera shows the whole midline from the inside, from the breastbone to below the navel. Every gap is closed with stitches. One large mesh is then laid to cover all of them with a wide margin. Where the layers allow, Dr Harsh Shah places the mesh outside the inner lining of the tummy. Where they do not, a coated mesh made to sit next to the bowel is placed inside and fixed. The choice is explained before you sign consent.

The laparoscopic view often finds a small gap that could not be felt. Repairing only the lump you can feel, and missing a second gap a few centimetres away, is a common reason these hernias seem to come back.

Laparoscopic or open: an honest comparison

Open repair is short and simple for one small gap. Laparoscopic repair suits several gaps or a widened midline, because one mesh can cover them all through small cuts.

Where open repair fits. Most epigastric hernias are single and small. For these, an open repair through a cut over the lump is quick and does not enter the tummy. It can be done under a spinal anaesthetic if needed. The scar sits in the midline and fades with time.

Where laparoscopic repair fits. When there are several gaps, repairing each from the front means a long cut or many cuts. When the midline is also widened, a small patch over one gap leaves the weak midline untreated. In heavier patients a large open wound is more likely to get infected. In each of these, the laparoscopic route does the job with smaller wounds.

What laparoscopic repair costs you. It needs a general anaesthetic and takes longer. The fixing stitches can ache for some weeks. When the mesh sits inside the lining, there is a small long-term risk of bowel sticking to it. For a single small gap, these costs are rarely worth it.

When Dr Harsh Shah advises waiting

A small epigastric hernia that does not hurt can be watched. A hernia that is painful, growing or will not go back is repaired.

A small lump that does not hurt. If you hardly notice it, watching is a fair choice. You are told the warning signs and seen again if it changes. Many people with this hernia do choose a repair later, often because the ache grows.

Things to fix first. Smoking, an untreated cough, constipation and high sugar all weaken healing. These are sorted out before a planned repair. If another pregnancy is planned and the hernia is comfortable, the repair can wait until the family is complete.

Not when it is stuck or painful. Because the neck is narrow, a plug of fat can get trapped and become very tender. That is a reason to repair rather than watch. A belt does not close the gap, as the note on whether a hernia belt helps explains.

What patients say

Your patient journey: five steps

  1. Book your consultation. Call or send a WhatsApp message to book a visit. Bring any ultrasound or CT report, your list of medicines, and details of any past operation on your tummy.
  2. Tests and treatment plan. The lump is examined and, if needed, scanned by ultrasound to count and measure the gaps. Blood tests and a heart tracing make sure the anaesthetic is safe. You leave knowing which repair is planned and why.
  3. The surgery. The repair is done at Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad. An open repair takes about an hour. A laparoscopic repair takes about one to two hours.
  4. Short hospital stay. Most patients go home the same day or the next morning. You walk within a few hours.
  5. Follow-up and full healing. You are seen at about one week for the wound and again at about six weeks. Desk work is usually possible within one to two weeks. Heavy lifting is built up slowly from about six weeks.

The day of surgery, hour by hour

This is how a planned repair usually runs at Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad. The times are a guide.

  1. Early morning. You arrive having had nothing to eat from midnight. Papers and insurance steps are completed. The anaesthetist sees you, and each lump is marked while you stand, because a small hernia can vanish when you lie down.
  2. The operation. The repair is done under general or spinal anaesthesia, as planned. Local numbing medicine is put into the wound so that you wake up more comfortable.
  3. Two to four hours later. You sit up, drink water and then eat a light meal. You walk with help.
  4. Going home. The wound is checked and your pain is reviewed. You get tablets, a list of warning signs, the date of your review and a phone number that is answered.

Cost, insurance and admission

The cost depends on open or laparoscopic repair, the mesh used, the stay and your health. Most health insurance policies cover epigastric hernia repair.

No single figure fits everyone, so none is quoted here. These are the things that move the estimate. A laparoscopic repair costs more than an open one. A coated mesh made to sit next to the bowel costs more than a plain mesh. Several gaps need a larger mesh. Diabetes or heart disease can mean extra tests and a longer stay. The room category you choose also changes the bill.

Cashless treatment is available at Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad with most insurers. Pre-approval is sought with the examination findings and any scan report attached. Our coordinator handles the forms and tells you before admission what has been approved. Bring your insurance card, a photo ID, your policy papers and all your reports. There is a fuller note on hernia surgery and your insurance claim, and a page on what hernia surgery costs in Ahmedabad.

Recovery and what can go wrong

Most people walk the same day and return to desk work within two weeks. A fluid collection under the wound is the most common problem, and it usually settles by itself.

The usual course. The wound is sore for a few days, most of all when you cough or sit up. Bruising is common. A firm swelling under the wound in the first weeks is usually fluid, called a seroma. It settles on its own in most people and is left alone. After a laparoscopic repair, the fixing stitches on the side can ache for a few weeks, and gas can cause shoulder pain for a day or two.

Problems to know about. The wound can get infected, more often in people who smoke, have diabetes or carry extra weight. Most infections settle with dressings and tablets. Mesh infection is rare, but it may need the mesh to be removed. During a laparoscopic repair the bowel can be injured. This is rare, and it is repaired at the same sitting.

The hernia coming back. A correctly sized mesh repair comes back in only a small share of people. When it does, there is usually a reason. A second gap was missed, the mesh was too small, or heavy lifting started too soon. Smoking, extra weight and a constant cough raise the risk. Read about lifting and the gym after hernia repair and about hernia surgery recovery time.

Questions patients ask

My lump is tiny. Why does it hurt so much?

Because the gap is narrow. A plug of fat is squeezed each time your muscles tighten, and that pinching hurts. A small epigastric hernia can be more painful than a large one with a wide neck.

Will an epigastric hernia go away with exercise or medicine?

No. Exercise can strengthen the muscles, but it cannot close the gap in the midline strip. Tablets do not help either. See the note on whether medicine can treat a hernia.

Do I need a mesh?

For a single gap under about one centimetre in a slim person, stitches alone may be enough. For most other gaps a mesh lowers the chance of the hernia coming back. The with-or-without-mesh note explains why.

I was told I have two lumps. Can both be fixed at once?

Yes. Several gaps along the midline are usually repaired together, often laparoscopically, so that one mesh covers all of them.

I also have a gap between my stomach muscles. Does that matter?

Yes. When the midline is widened, a patch over the hernia alone may not last. The widening is often treated in the same operation. The diastasis recti repair page explains this.

How long will I be off work?

Most people go back to desk work in one to two weeks. Heavy physical work usually needs four to six weeks.

Which warning signs mean I should go to hospital?

A lump that becomes hard and very painful and will not go back, especially with vomiting. Go to the hospital the same day. Read more on warning signs of a trapped hernia.

Where Dr Harsh Shah sees and operates

Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Plot No. 1 A, Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007
Directions to Dr. Jivraj Mehta Hospital, Vasna · +91 63555 64601

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Hernia Surgery — Dr Harsh Shah
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