My daughther has had a small extrusion of skin in her stomach region. 
Our general practitioner in a routine checkup suggested we see a
specialists.

The specialists examined my daughter and concluded it was a
Epiplocele, commonly known as a ventral hernia or epigastric hernia.

He commented that it could become probematic over time as she grows --
for example, a layer of fat could cover over the hernia area and then
sudden pain arise, but it will be more complicated to address in the
future because the appearance of the hernia becomes hidden by the fat.

Or it may never really cause any problems at all.

His recommendations was to perform a minor out-patient surgery to
correct the problem.

I, personally, am uncomfortable with speculative/preventative surgery.
 In part, I am skeptical of the *business* of just recommending
surgery to provent something that only "might" be a future problem.

The first part of my question is what is the liklihood of future
problems?

While no one will be able to ultimately answer "Should we have this
surgery?" except ourselves (my wife & I).  I am looking for
professional feedback concerning this situation.

I have searched a few of the medical sites, and see this is a common,
minor-risk procedure that is frequenlty done in children on an
out-patient basis.

What else can be said about this to give us education & insight into
this situation?

Thank you.

Dear webhosting,

I guess my first question would be, would it be possible for you to
get a second (or even third) professional opinion?

That said, here is what "The Columbia University College of Physicians
and Surgeons Complete Medical Guide": NY, Crown Pub. (©1985), has to
say:

"Hernia: Our internal organs are sheathed and held in place by a wide
band of muscle extending from the groin to the ribs. Without this,
they would bulge out. As a result of a sudden strain, a weak point in
the muscle wall may tear, allowing the interanl organs, most often the
intestine, to squeeze through the gap... The danger is that if the
intestine has pushed through the muscle wall, its contents can be
prevented from moving. This is called an obstructed hernia. The more
severe danger is that the blood supply to the intestinal segment will
be cut off and the tissue will die, resulting in gangerene. In both
cases, surgery will probably be needed and medical attention should be
sought as soon as the uncharacteristic bulging is noticed."

I'm sure that is a simplified version of what you have already found
online, but it does underline the importance of early treatment. I can
understand your reluctance to authorize surgery for your little girl,
but minor surgery now might prevent major surgery later (would you
really want to risk that?).  If you don't have complete trust in her
surgeon, perhaps finding someone else would be all that is needed to
put your minds at rest.

I suspect you and your wife have become "experts" on this condition
and there is really little we can offer in the way of medical
expertise. As parents, we often have to make difficult decisions (this
won't be your last, that's for sure!) and the bottom line always comes
down to doing what's best for your child. If minor surgery today will
prevent a chance of needing emergency major surgery later, then I
think you have to ask yourselves "Why shouldn't we do it?" rather than
"Why should we do it?".

Link:

eMedicine: Abdominal Hernias
http://www.emedicine.com/med/topic2703.htm

Search Strategy:

://www.google.ca/search?as_q=pediatric&num=100&hl=en&ie=UTF-8&oe=UTF-8&btnG=Google+Search&as_epq=Epiplocele&as_oq=&as_eq=&lr=&as_ft=i&as_filetype=&as_qdr=all&as_occt=any&as_dt=i&as_sitesearch=&safe=images

Terms Used:

pediatric 
"Epiplocele"


Wishing you all well. As they say "Parenting is the hardest job in the
world" - you sound like you're the cream of the crop.
Sincerely,
hummer

---

Request for Answer Clarification by webhosting-ga on 06 Nov 2002 07:56 PST

hummer, your answer is appreciated. 

However, I do not think you provided the "professional feedback" that
I was asking for, but rather you gave more of a focus on what your
opinion was of good parenting in this situation.

Again, I appreciate such feedback, but I do not think you should have
answered the question -- your absence of any direct and professional
knowledge and/or experience concerning the actual topic in question is
evident.

I am very thankful of the comment provided by surgeon-ga.  This is the
exact type of answer I was hoping to get.  Is it possible for you to
withdraw your answer and allow surgeon-ga's comment to exist as the
official answer?

Thank you.

---

Clarification of Answer by hummer-ga on 06 Nov 2002 09:38 PST

Hi Webhosting,

Sure, you can ask for a free reposting (or a refund) for up to 30 days
after the answer is posted.  If you repost, put "for surgeon-ga only"
in the title so noone else answers it. Unfortunately, I haven't any
experience with doing it so I can't give you directions on how to
proceed. I've checked to see if there is a way to withdraw my answer
but haven't had much luck - I guess you have to reject it from your
end. Don't worry about it, I understand completely.

Thank you surgeon-ga for your professional answer.

Webhosting, I'm sorry for the inconvenience I've caused - best of luck
with your decision.
hummer

---

Clarification of Answer by hummer-ga on 07 Nov 2002 07:13 PST

Dear webhosting,

Hi, it's me again. I checked the Answers FAQ and it states:  "If you
are not fully satisfied with your answer for whatever reason, the
first step is to request a clarification of your answer from the
original Researcher. If you are still dissatisfied after
clarification, you can request your question be re-posted once again."
 You've already requested the clarification, so as far as I can see,
the next step would be to request to have your question reposted.

hummer

---

Request for Answer Clarification by webhosting-ga on 07 Nov 2002 08:57 PST

hummer, 

Thank you.  I'm going to leave as is.  While your answer was less
pragmatic and a little more philosophical than I was searching, on
second thoughts I don't believe it deserves removal.  It was a good,
thoughtful answer.

What would be cool, if Google Questioners could simply 'tip' someone
who posts a comment.

Thanks again.

---

Clarification of Answer by hummer-ga on 07 Nov 2002 19:00 PST

Dear webhosting,

Thank you for your thank you and for your thoughtful response, I
appreciate it.  While thinking about you and our correspondence, it
occurred to me that although it may seem unfair at times for some
contributors (commentors), it all balances out in the end. I myself
have been able to add to some answers by posting a comment, as have
most researchers. Noone forces us to post comments, and we all know
that we won't get paid for it. But the important thing in the end is
that the person who asked the question receives the most complete and
accurate answer as possible and hopefully we all learn something in
the process.

That said, I think your idea about making it possible to tip
commentors is a terrific idea. It's possible the powers-that-be have
already considered it but the legistics of setting it up was more than
they were ready to do. Nice thought, though.

Take care,
hummer

epigastric hernia is fairly common; problems with them are less
common, and rarely are serious. In epigastric hernia, particularly
small ones, the protrusion is a glob of fat from just behind the
muscle. The danger of a hernia is that whatever is pushing through the
hole could get its blood supply cut off, and start to die. This is
rare for an epigastric hernia, and were it to occur, it would become
painful, but not dangerous, because it's fat and not intestine. It
might or might not enlarge. The operation for epigastric hernia is
indeed simple, quick, outpatient, safe, and relatively pain-free.
However, there's no urgency. No way to predict if problems will occur.
It very likely would wait until she's old enough to decide for
herself. If it causes problems, it's much more likely to be tenderness
or soreness than something requiring urgent intervention. I have
operated on countless epigastric hernias, very often in kids. It's
almost always because they have started to bug the kid. When they
don't, I haven't recommended doing anything unless the kid or parents
decide they don't want to worry about it.

surgeon, 

Thank you for your response.  The epgastric hernia is small (smaller
than a quarter), and the extrusion can best be seen when she lifts her
arms or otherwise pushes her stomach out -- when she is standing
normally, it is barely visible, and it disappears completely, if she
relaxes, sits or lays down...

You mentioned that there is "no urgency".  One of the things the
specialist mentioned was that as our daughter grows the area could
become covered up, or not externally apparent.  If that were to be the
case and related problems did occur, the dr said it could complicate
matters trying to find the exact spot of the epigastric hernia,
indicating that a future surgery might be not as simple or quick as
taking care of it presently.  Should this be of concern?

The concept of the area becoming "covered up" and harder to find if
surgery were necessary in the future is a, shall we say, novel one in
my experience.  Perhaps if she ends up massively obese....Basically,
if such a hernia gives symptoms they are localized to the exact area,
and should be easily localizable. Often we mark the area while the
patient is standing for the reason you suggested: when lying on the
operating table the hernia may disappear. In an adult, localized
symptoms without a palpable (feelable) hernia can be evaluated with
ultrasound....the bottom line is the hernia will not go away. It may
or may not become symtomatic. If it does, no matter what the age, the
operation is highly likely to be simple and quick.  I think, in
general (allow me the cover-my-rear statement that not being able to
see and feel and talk about it face to face, I'm speaking in
generalities) there is no urgency to operate, and it's safe to allow
time to pass. One last thing: I just answer the occasional question
here when I think I can help. I'm not a "paid" researcher.

Hi, I have read the question and the answer/comments. In this cases,
it is better to have a 2nd or 3rd opinion, isnt'it?

I would like to add something: a link from THE BRITISH HERNIA CENTRE.
http://www.hernia.org/

Have also a look to:

http://www.hernia.org/end.html
A COMPLETELY FREE SERVICE 
If you are interested in the modern, specialised approach to hernia
surgery
and would like us to advise what we can do in your own case, 
wherever you may live in the world, 
we have devised a simple interactive routine to establish what you
need

{below I have included part of what they have published on-line
related to pediatric umbilical hernias. Moreover, you have the
possibility to send them an email asking for their recommendation for
your particular topic).

Umbilical hernia 

This is one of the most common paediatric surgical conditions
affecting, perhaps, 1 in 5  (20%) of all children.

Umbilical hernias are more common in premature babies and children
with Down's syndrome and there is a slight familial tendency.

They appear as a bulge at the umbilicus, (the navel) which can vary in
size from that of a pea up to the size of a small plum. They are not
usually painful and are much more obvious when the baby or child cries
or strains.

What happens if they are not treated? ~ Do they need an operation? 

There is a general agreement that most infantile umbilical hernias
will eventually close spontaneously, though experts disagree over what
period of time.  Probably 80 to 90% of umbilical hernias will have
closed by the time the child is 3, but the larger ones may be present
up to 11 years before finally closing. The time taken to close
probably depends on the size of the hole / defect / opening with 95%
of umbilical hernias less than 0.5 cm in diameter, closing by the age
of 2 years. Umbilical hernias present after puberty will probably not
close spontaneously.

In the case of infantile umbilical hernias, problems, particularly
strangulation - where a portion of intestine becomes trapped in the
hernia, rarely occur, so that surgery is rarely required. However the
presence of pain in the hernia, particularly if associated with
vomiting or constipation requires an urgent surgical opinion and
possible operation.

Kind regards,
Tom136

Sorry, I forgot an important link. Here it is...
http://www.hernia.org/paeds.html

Kind regards.
Tom136
(note: I have nothing to do with the British Hernia Centre. I included
this info only because I thought that it might be useful for you).

SORRY AGAIN:
I wrongly included a paragraph from the BRITISH HERNIA CENTRE about
PEDIATRIC UMBILICAL HERNIAS in ONE OF MY PREVIOUS COMMENTS. But you
clearly stated in your query that your daughter's hernia is an
EPIGASTRIC HERNIA, EPIPLOCELE OR VENTRAL HERNIA. Sorry for the
mistake. Anyway, you may consider to ask them for your particular case
(I understand that they give general advice on a free basis).
Kind regards. Sorry for the inconveniences that the addition of the
paragraph may have produced.
Tom136