Paraumbilical hernia is a common type of ventral hernia occurring in adults, typically near the umbilicus. It arises due to a weakness in the linea alba or abdominal wall fascia, often exacerbated by increased intra-abdominal pressure. If left untreated, paraumbilical hernias may enlarge, cause discomfort, or even lead to complications like incarceration or strangulation of abdominal contents. Over the past decades, laparoscopic techniques have revolutionized hernia repair, offering a minimally invasive approach with reduced postoperative pain, shorter hospital stay, and faster recovery. Dr. R. K. Mishra, a pioneer in laparoscopic surgery, has refined the laparoscopic paraumbilical hernia repair technique, making it both safe and highly effective.

Introduction

Paraumbilical hernias typically occur in middle-aged adults, with a higher prevalence in women and obese individuals. Risk factors include chronic cough, multiple pregnancies, obesity, constipation, heavy lifting, and prior abdominal surgeries. Patients commonly present with a bulge near the navel, which may be associated with pain or discomfort during activity.

Traditional open repair involves a larger incision, longer recovery, and a higher risk of wound complications, particularly in obese patients. Laparoscopic repair, as performed by Dr. Mishra, provides superior visualization of the defect, allows for precise reduction of hernia contents, and facilitates mesh placement with adequate overlap, ensuring durable repair and low recurrence rates.

Indications

Surgery is indicated in patients with:

Symptomatic paraumbilical hernia causing discomfort or pain

Enlarging hernia over time

Irreducible or incarcerated hernia

Complications such as bowel obstruction or strangulation

Patient preference for definitive repair, especially for cosmetic reasons

Laparoscopic repair is particularly advantageous in obese patients, recurrent hernias, or multiple defects, where open repair may be challenging or risky.

Preoperative Evaluation

Before surgery, patients undergo thorough evaluation to ensure safety and optimal outcomes:

Clinical examination to assess hernia size, reducibility, and any associated defects

Imaging studies such as ultrasound or CT scan for large or complex hernias

Laboratory investigations including complete blood count, coagulation profile, and renal function

Optimization of comorbid conditions, such as diabetes, hypertension, or respiratory disorders

Anesthesia assessment to ensure patient suitability for general anesthesia

Prophylactic antibiotics are administered preoperatively, and patients are counseled about the procedure, recovery, and potential risks.

Surgical Technique by Dr. R. K. Mishra

Dr. Mishra emphasizes a structured approach to laparoscopic paraumbilical hernia repair for safety and efficacy:

Anesthesia and Positioning

The procedure is performed under general anesthesia.

The patient is positioned supine, with slight Trendelenburg tilt to optimize exposure of the umbilical region.

Port Placement

Pneumoperitoneum is established using a Veress needle or open technique.

A 10 mm camera port is placed away from the hernia to avoid injury to the sac.

One or two 5 mm working ports are inserted under vision for instrument access.

Hernia Content Reduction

The hernia sac is identified and carefully dissected.

Hernia contents, such as omentum or bowel, are gently reduced into the abdominal cavity.

Adhesions, if present, are lysed to allow proper visualization and mesh placement.

Defect Assessment and Closure

In small defects, primary fascial closure can be performed laparoscopically using non-absorbable sutures.

For larger defects or recurrent hernias, mesh reinforcement is preferred to reduce recurrence risk.

Mesh Placement

A composite or dual-surface prosthetic mesh is introduced intraperitoneally.

The mesh is positioned to cover the defect with at least 3–5 cm overlap on all sides.

Mesh fixation is achieved using tackers, transfascial sutures, or fibrin glue, depending on surgeon preference and patient anatomy.

Completion

Hemostasis is confirmed, and the peritoneum is closed if needed to prevent adhesions.

Ports are removed, pneumoperitoneum released, and skin incisions closed.

Postoperative Care

Early mobilization is encouraged to reduce the risk of thromboembolism.

Oral intake is resumed as tolerated, and pain is managed with oral analgesics.

Hospital stay is usually 24–48 hours depending on patient recovery.

Patients are advised to avoid heavy lifting and strenuous activity for 4–6 weeks to allow proper healing.

Outcomes and Advantages

Dr. Mishra’s experience demonstrates that laparoscopic repair of paraumbilical hernia provides:

Low recurrence rates due to precise mesh placement and defect coverage

Reduced postoperative pain and faster return to daily activities

Lower wound-related complications, especially in obese patients

Improved cosmetic outcomes with minimal scarring

Ability to identify and repair multiple or occult defects in a single procedure

Potential Complications

Although generally safe, potential risks include:

Injury to bowel or major vessels during adhesiolysis or port placement

Seroma or hematoma formation

Mesh-related complications such as infection or migration

Rare recurrence if mesh fixation is inadequate

With meticulous technique and adherence to laparoscopic principles, these complications are minimized.

Conclusion

Laparoscopic repair of paraumbilical hernia by Dr. R. K. Mishra represents a modern, safe, and effective approach for adult patients. It combines the advantages of minimally invasive surgery—reduced pain, faster recovery, and superior cosmetic results—with durable hernia repair and low recurrence rates. Careful patient selection, structured surgical technique, and meticulous postoperative care ensure excellent outcomes, making this procedure a preferred choice for paraumbilical hernia management today.