Background Pre-existing umbilical defects may present technical proble
ms in patients having laparoscopic surgery. Fascial defects map also o
ccur after operation. Understanding the causes and mechanisms of herni
ation at laparoscopic port sites may help avoid potentially serious po
stoperative complications. Methods The incidence, management and poten
tial complications of pre-existing and postoperative umbilical defects
were studied in 870 patients undergoing laparoscopic cholecystectomy.
Results The incidence of umbilical or paraumbilical defects was 12 pe
r cent, The hernias were symptomatic in only 16.3 per cent, the majori
ty of patients were unaware of the defect, The umbilical port was esta
blished through, or directly adjacent to. the defect, allowing simple
anatomical repair in 90 per cent, using absorbable sutures, The recurr
ence rate was 3.8 per cent recurrence was usually caused by wound exte
nsion or infection. Incisional hernia occurred in 16 patients after ch
olecystectomy (1.8 per cent), Only one hernia developed at a port site
other than the umbilicus, Risk factors associated with incisional her
nia were wound extension in 12 patients, male sex in six, wound infect
ion in five, diabetes in four, pre-existing umbilical hernia in four a
nd acute cholecystitis in three. Conclusion The significant incidence
of umbilical defects in patients undergoing laparoscopic surgery calls
for accurate diagnosis and good technique. The incidence of incisiona
l hernia might be reduced by avoiding unnecessary wound extension and
the use of non-absorbable sutures for defects larger than 2 cm and in
men with umbilical hernia.