Which of the following statement(s) is/are true concerning the diagnosis and management of epigastric hernias?

b. At the time of surgical repair, a careful search for other defects should be performed

Epigastric hernias are usually small but they vary considerably in size. Most of these defects occur in the midline. The small defects contain only preperitoneal fat with no sac. With increasing size, fat in the falciform ligament and eventually a peritoneal sac and abdominal viscera may be contained within the hernia. The preperitoneal fat in the small defect is usually incarcerated. Multiple defects may be present in up to 20% of patients. Surgical treatment is recommended in all adult patients with symptoms or with a hernia defect greater than 1.5 to 2 cm. in diameter. Methods of repair depend upon the size of the defect. For small defects, simple closure with obliquely placed sutures after reduction or removal of the preperitoneal fat from the defect has been recommended. However recurrent epigastric hernias in up to 10% of the cases have been reported with this method, most likely as a result of additional undetected or unrepaired weaknesses in the epigastric midline.