Hernias are among the most frequently encountered surgical conditions worldwide, and paraumbilical hernia is one of the common types. It occurs near the umbilicus, where natural weakness in the abdominal wall predisposes to herniation. In adults, paraumbilical hernias are usually acquired and often increase in size over time. With the advent of minimally invasive techniques, laparoscopic surgery for paraumbilical hernia has become the preferred approach due to its safety, effectiveness, and superior postoperative outcomes.

Understanding Paraumbilical Hernia

A paraumbilical hernia arises when abdominal contents, such as omentum or bowel loops, protrude through a defect adjacent to the umbilicus. Unlike congenital umbilical hernias in children, paraumbilical hernias in adults rarely resolve spontaneously and usually require surgical correction.

Risk factors include:

Obesity and sedentary lifestyle

Multiple pregnancies

Chronic cough or constipation causing raised intra-abdominal pressure

Ascites or chronic liver disease

Previous abdominal surgeries

Patients often present with a visible swelling near the navel that enlarges on coughing or straining. Some may experience discomfort, pain, or complications such as obstruction or strangulation of bowel contents.

Indications for Surgery

Definitive treatment of paraumbilical hernia is surgical. Non-surgical measures such as abdominal binders only provide temporary relief and do not prevent complications. Surgery is indicated in:

Symptomatic hernias with pain or discomfort

Increasing size of hernia

Irreducible hernias or those at risk of strangulation

Complicated cases with obstruction or ischemia (emergency surgery)

Why Laparoscopy?

Traditional open hernia repair is effective but often associated with larger incisions, more pain, and longer hospital stay. Laparoscopic surgery offers several advantages:

Smaller incisions with reduced postoperative pain

Better visualization of hernia defect and surrounding structures

Placement of larger mesh with excellent coverage of defects

Reduced risk of wound infection, particularly in obese patients

Shorter recovery time and early return to daily activities

Cosmetic benefits with minimal scarring

Preoperative Preparation

Patients undergo a thorough clinical examination and imaging if required to assess defect size.

Medical conditions like diabetes, obesity, or chronic cough should be optimized before surgery.

Preoperative investigations include blood tests, chest X-ray, and ECG as indicated.

Prophylactic antibiotics are administered, and bowel preparation may be done in selected cases.

Surgical Technique of Laparoscopic Paraumbilical Hernia Repair

The procedure is performed under general anesthesia with the patient in a supine position.

Port Placement

Pneumoperitoneum is created using a Veress needle or open technique.

A 10 mm camera port is usually placed away from the hernia site.

Additional 5 mm or 10 mm working ports are positioned under vision for ergonomic access.

Defect Identification and Reduction

The hernia sac is visualized, and its contents (omentum or bowel) are reduced back into the abdominal cavity.

Adhesiolysis is performed if the hernia contents are stuck.

Defect Closure (Optional)

Some surgeons prefer to close the fascial defect laparoscopically with sutures before mesh placement, especially for larger defects, to restore abdominal wall integrity.

Mesh Placement

A prosthetic mesh, usually composite or dual-surface, is introduced into the abdomen.

The mesh is placed intraperitoneally to cover the defect with at least 3–5 cm overlap in all directions.

Fixation is achieved with tackers, sutures, or fibrin glue.

Completion

After confirming hemostasis and secure mesh placement, pneumoperitoneum is released and ports are closed.

Postoperative Care

Patients are encouraged to ambulate early to reduce risks of thromboembolism.

Oral intake is usually resumed within a few hours.

Pain is managed with oral analgesics, and most patients are discharged within 24–48 hours.

Patients are advised to avoid heavy lifting and strenuous activity for at least 4–6 weeks.

Outcomes and Advantages

Laparoscopic paraumbilical hernia repair has shown excellent results in terms of safety, effectiveness, and recurrence prevention. Studies reveal:

Low recurrence rates, provided mesh of adequate size is used.

Rapid recovery, with most patients resuming normal activity within days.

Fewer wound-related complications, especially in obese individuals who are at higher risk with open surgery.

Improved quality of life, with less postoperative discomfort and better cosmetic satisfaction.

Risks and Complications

While generally safe, potential risks include:

Injury to bowel or blood vessels during adhesiolysis

Seroma or hematoma formation at the repair site

Mesh-related complications such as infection or migration

Chronic pain or recurrence if repair is inadequate

Most complications are rare when surgery is performed by experienced laparoscopic surgeons.

Conclusion

Laparoscopic surgery for paraumbilical hernia has become the gold standard in modern hernia management. It provides excellent visualization, secure mesh placement, and minimal postoperative morbidity. Compared to open repair, it offers reduced pain, quicker recovery, and better cosmetic outcomes. With proper patient selection, preoperative preparation, and surgical expertise, laparoscopic paraumbilical hernia repair ensures durable results and significantly enhances patient quality of life.