https://www.laparoscopyhospital.com/SERV01.HTM<br /><br />Umbilical hernias are common surgical conditions encountered in adults, often necessitating repair due to the risk of complications such as incarceration or strangulation. With the advent of laparoscopic surgery, minimally invasive techniques have become the gold standard for hernia repairs, offering faster recovery, less postoperative pain, and reduced risk of infection. In this article, we will discuss the laparoscopic repair of a small umbilical hernia using the Mishra’s knot technique and a dual mesh, emphasizing key steps and tips for a successful outcome.<br /><br />Indications for Laparoscopic Umbilical Hernia Repair<br />Laparoscopic repair is indicated in patients with symptomatic umbilical hernias, particularly those with recurrent hernias, obese patients, or those seeking faster recovery. Small umbilical hernias, defined as defects less than 3 cm in diameter, can be effectively repaired using a combination of non-absorbable sutures (Mishra's knot) and a dual mesh to reinforce the defect.<br /><br />Step-by-Step Surgical Technique<br />1. Initial Access and Creation of Pneumoperitoneum<br />Mishra's point access is used to introduce a 10 mm trocar under direct vision using the open (Hasson) technique. CO₂ insufflation is initiated to create a pneumoperitoneum with an intra-abdominal pressure of 12-14 mmHg.<br />A 30° laparoscope is inserted to visualize the hernia defect and surrounding anatomy.<br />2. Reduction of Hernia Sac<br />The hernia sac contents, if present, are gently reduced back into the peritoneal cavity using atraumatic graspers.<br />Ensure complete reduction of any omental or small bowel contents to prevent future complications.<br />3. Preparation of the Hernia Defect<br />The edges of the hernia defect are cleaned of any preperitoneal fat. This step is crucial for proper mesh placement and fixation.<br />Measure the defect size to determine the appropriate size of the dual mesh to be used.<br />4. Closure of the Defect with Mishra's Knot<br />The hernia defect is closed using Mishra's knot, a secure extracorporeal knot-tying technique that provides reliable tension and strength. Non-absorbable polypropylene (0) suture is typically used.
