An umbilical hernia is one of the most common ventral hernias encountered in surgical practice. It occurs when intra-abdominal contents protrude through a weakness in the abdominal wall near the umbilicus. Although umbilical hernias can be congenital, in adults they are typically acquired due to increased intra-abdominal pressure or weakening of the abdominal fascia. With advances in minimally invasive surgery, laparoscopic repair of umbilical hernia has become the preferred option for many patients and surgeons, offering faster recovery, reduced postoperative pain, and superior cosmetic results compared to traditional open repair.

Understanding Umbilical Hernia

In adults, umbilical hernias are often caused by factors that increase intra-abdominal pressure or compromise the strength of the abdominal wall. Risk factors include:

Obesity

Chronic cough or constipation

Pregnancy and multiple childbirths

Ascites from chronic liver disease

Heavy lifting or straining

Previous abdominal surgery

Patients may present with a swelling or bulge at the umbilicus that increases with coughing or standing. Symptoms vary from mild discomfort to severe pain, especially if complications such as strangulation or bowel obstruction occur.

Indications for Surgery

Not all small, asymptomatic umbilical hernias require immediate intervention. However, surgical repair is indicated when:

The hernia is symptomatic (pain or discomfort).

The size of the hernia is increasing.

The hernia is irreducible or incarcerated.

Complications like obstruction or strangulation occur.

The patient desires definitive repair for cosmetic or lifestyle reasons.

Advantages of Laparoscopic Repair

Compared with open repair, laparoscopic umbilical hernia repair offers numerous benefits:

Smaller incisions, leading to less postoperative pain.

Enhanced visualization of the defect and surrounding tissues.

Ability to identify and repair occult or multiple defects.

Lower infection rates, especially in obese patients.

Quicker recovery and shorter hospital stay.

Better cosmetic outcomes with minimal scarring.

Preoperative Preparation

Patients undergo a thorough evaluation that includes:

Clinical examination and imaging (ultrasound or CT scan if needed).

Optimization of comorbid conditions like diabetes or chronic cough.

Cessation of smoking and weight management for obese patients.

Routine investigations including blood work and anesthesia assessment.

Prophylactic antibiotics are administered before surgery to reduce the risk of infection.

Surgical Technique

Dr. R. K. Mishra and other laparoscopic experts describe the following steps in detail:

Anesthesia and Positioning

The patient is placed in a supine position under general anesthesia.

A Foley catheter may be inserted in selected cases.

Port Placement

Pneumoperitoneum is established using a Veress needle or open technique.

A 10 mm camera port is usually placed away from the defect, often supra- or infraumbilical.

Two additional 5 mm or 10 mm working ports are inserted under direct vision.

Defect Identification

The hernia defect and sac contents are visualized.

Hernia contents, such as omentum or bowel loops, are carefully reduced into the peritoneal cavity.

Adhesiolysis may be required if the sac is adherent.

Defect Closure (Optional)

Some surgeons prefer to close the fascial defect with intracorporeal suturing before mesh placement to restore abdominal wall strength.

Mesh Placement

A composite or dual-surface prosthetic mesh is introduced into the peritoneal cavity.

The mesh is placed intraperitoneally with at least 3–5 cm overlap beyond the defect margins.

Mesh fixation is achieved using tackers, transfascial sutures, or fibrin glue.

Completion

Pneumoperitoneum is released gradually after ensuring hemostasis and secure fixation.

Ports are removed and incisions closed with sutures or skin staples.

Postoperative Care

Patients are mobilized early, often within hours of surgery, to reduce the risk of thromboembolic events.

Oral fluids are started once fully awake, and diet is gradually advanced.

Pain is managed with oral analgesics, and hospital stay is usually 24–48 hours.

Patients are advised to avoid strenuous activity, heavy lifting, or abdominal strain for 4–6 weeks.

Outcomes of Laparoscopic Repair

Studies have consistently shown excellent results for laparoscopic umbilical hernia repair:

Low recurrence rates when appropriate mesh placement and fixation are performed.

Reduced postoperative morbidity, particularly in obese patients who have higher risks with open surgery.

Improved patient satisfaction due to less pain, early return to work, and better cosmetic appearance.

Potential Risks and Complications

While generally safe, laparoscopic umbilical hernia repair may be associated with:

Bowel or vascular injury during entry or dissection.

Seroma or hematoma formation.

Mesh-related complications such as infection or migration.

Chronic pain at fixation sites.

Rare recurrence if defect closure or mesh placement is inadequate.

Most complications are minimized when performed by skilled surgeons with strict adherence to surgical principles.

Conclusion

Laparoscopic repair of umbilical hernia is a safe, effective, and minimally invasive procedure that has become the standard of care for many patients. It provides superior outcomes compared to open repair, including reduced pain, quicker recovery, and better cosmetic satisfaction. With proper patient selection, careful preoperative preparation, and precise surgical technique, laparoscopic repair offers durable results and significantly enhances patient quality of life