Laparoscopic Umbilical Hernia Repair in Antalya | IPOM-Plus & eTEP

What Is Laparoscopic Umbilical Hernia Repair?

A minimally invasive operation in which the umbilical defect is closed from inside the abdomen and reinforced with a mesh placed on the inner abdominal wall. Intra-abdominal CO₂ pressure presses the mesh against the wall, providing durable repair with a low recurrence rate.

Who Is a Candidate?

• Umbilical defects between 1 cm and 6 cm
• Multiple defects on the midline (e.g. umbilical + epigastric)
• Recurrent umbilical hernia after previous open repair
• Patients with obesity (BMI 30–40), as wound infection risk is lower than with open surgery
• Active patients aiming for early return to work

Who May Not Be a Good Candidate?

• Very small (<1 cm) defects — open primary closure may be sufficient
• Very large (>10 cm) defects — open component separation may be more appropriate
• Extensive intra-abdominal adhesions from multiple prior surgeries
• Severe cardiac or pulmonary disease that precludes general anaesthesia
• Active intra-abdominal infection

Preoperative Preparation

Routine blood tests, ECG and, when needed, chest imaging are performed. Smoking cessation is advised at least 2 weeks before surgery. Anticoagulant and antiplatelet medications are reviewed and planned with the surgical team. In patients with obesity, 5–10% weight loss before surgery reduces tension on the defect and lowers recurrence risk.

Anaesthesia

General anaesthesia is required because abdominal wall relaxation and controlled CO₂ insufflation are needed. A transversus abdominis plane (TAP) block can be added to improve pain control during the first 24 hours.

Surgical Techniques: IPOM, IPOM-Plus and eTEP

IPOM (Intraperitoneal Onlay Mesh) places a composite mesh inside the abdomen with an anti-adhesion coating facing the bowel. IPOM-Plus adds laparoscopic closure of the defect before the mesh is placed; this reduces seroma and recurrence and is the current standard. eTEP (Extended Totally Extraperitoneal) places the mesh in the retromuscular plane without entering the abdominal cavity — useful for 3–10 cm defects and when rectus diastasis coexists.

Mesh (Materials)

• Composite meshes (polypropylene with anti-adhesion coating) — standard for IPOM/IPOM-Plus
• Lightweight, large-pore polypropylene meshes — suitable for eTEP
• PVDF-based meshes — long-term durability
• Biosynthetic/biologic meshes — selected contaminated cases

Step-by-Step Outline

• General anaesthesia, supine position, prophylactic antibiotics
• Pneumoperitoneum (12 mmHg) via Veress or open Hasson entry
• Three small ports (5–12 mm)
• Adhesiolysis if needed; reduction of hernia contents
• Measurement and laparoscopic closure of the defect (IPOM-Plus / eTEP)
• Placement of a mesh covering at least 4–5 cm beyond the defect
• Mesh fixation with absorbable tackers and/or transfascial sutures
• Desufflation and port-site closure

Recovery Timeline

• 0–24 h: discharge, light walking, soft diet
• 2–5 days: showering allowed, mild tenderness controlled with analgesics
• 1 week: office work, follow-up visit
• 2–3 weeks: full daily activities
• 4–6 weeks: gradual return to lifting and abdominal exercises
• 3 months: mesh integration completes; final result

Risks

• Seroma — most common, usually resolves spontaneously in 6–8 weeks
• Wound infection — significantly lower than with open surgery
• Port-site pain or transient sensory change
• Bowel injury — 0.1–0.5% in experienced hands
• Mesh infection — rare (<1%) but serious
• Recurrence — 2–5% with appropriate technique

Open vs. Laparoscopic Comparison

Open repair uses a single 4–10 cm incision under local, spinal or general anaesthesia with a 1–2 day hospital stay and 2–4 week return to work; recurrence with primary suture is 10–20% and with mesh 5–10%. Laparoscopic repair uses three small ports under general anaesthesia, allows same-day or one-night discharge, return to work in 5–10 days, and recurrence of 2–5%. Multiple defects can be addressed in a single session.

Recurrent Umbilical Hernia

After a previous open repair, the laparoscopic approach avoids working through scarred tissue, allows adhesions to be released under direct vision and reinforces the wall with healthy tissue — reducing the risk of a second recurrence.

Obesity and Diabetes

In patients with obesity or diabetes, the small port incisions of the laparoscopic technique reduce wound infection from up to 15% (open) to 1–2%. Preoperative HbA1c below 7.5% and 5–10% weight loss support both technical ease and lower recurrence.

Care Pathway in Antalya

Examination and ultrasound assessment; surgical planning (IPOM-Plus vs eTEP, mesh choice); anaesthetic consultation; admission on the day of surgery; 45–90 minute procedure; same-day or next-morning discharge with written instructions; follow-up at 7–10 days, 1 month and 3 months.

Emergency Warning Signs

A bulge at the navel that becomes red, hard, cannot be reduced and is associated with nausea or vomiting may indicate a strangulated hernia and requires immediate emergency care.