I have repaired an umbilical hernia at the same setting as a lap chole. First, an incision was made over the hernia sac. When the fascial edges were well defined, sutures were placed and the Hasson trochar was introduced through the hernia. It was very difficult to obtain a tight enough seal to contain the pneumoperitoneum, so the hernia was partially repaired (Mayo style...vest over pants) and then it was much easier. Still, it continually leaked through the procedure and if I had it do to over again (and I'm sure I will) I would have reduced but not repaired the hernia, then placed the Hasson trochar superior to it (to avoid any adhesions), performed the lap chole, and repaired the hernia at the end.