I would go for epigasteic own access 10mm port ...lateral ports and if adhesions behind bilicus are easy take them down . Of not a camera port in right flank away from rectus to avoid inferior epigasteic artery. You can also go through the mesh with a 5mm port if here are no adhesions you don't need to close it at the end.

Better to avoid repair with mesh at the same time . But that depends on size and symptoms . You can repair from outside without a port site near the hernia

i will generally go through the hernia as many of them are about the size of the fascial defect i would be creating. If the defect is larger, I will generally stage the operations and not do them at the same time. I never put mesh in when doing a gall bladder or other clean-contaminated case.

Like Dan, I place my trocar through the hernia. After removing the gallbladder, the defect is primarily repaired without using a mesh. As the recurrence is very high, this done with the intention to do laparoscopic hernia repair at a later date i.e. staged.

The first port could be introduced through the umbilicus via open technique after reducing the hernia and making sure that there is no adherent bowel.The gall bladder can be extracted through the epigastric port.

It should also be considered whether the case is Cholelithiasis or Cholecystitis .In case of Cholecystitis or with intraoperative bile spillage, it would be advisable not to use a mesh to repair the umbilical defect. In case of cholelithiasis alone and if the defect is large( > 2cm) a mesh may to be used and it can be placed over the rectus and a culture should be taken from the gall bladder ,just in case it gets infected. The ideal situation would be primary suture closure if the defect is small and follow up with a view to identify possible recurrence.

Some answers are absolutely correct for a fresh umbilical hernia...but disregarded the fact that there has already been:

1- a mesh repair

2- recurrent umbilical hernia i.e incisional hernia

Access at site of previous incisional hernia repair with mesh is NOT a good idea.

I am repeating my answer (After correcting a lot of typing mistakes!!)

I would go for epigastric open access with a 10mm port ...and then lateral ports. If adhesions behind umbilicus are easy; take them down . If not, use a lateral camera port in right flank away from rectus to avoid inferior epigastric artery. You can also go through the mesh with a 5mm port if here are no adhesions and you don't need to close it at the end.

My colleague just published an article regarding this:

"Jategaonkar PA1, Yadav SP. Mesh/Meshless paraumbilical hernia repair with concomitant single-incision transumbilical three-port laparoscopic cholecystectomy-prospective observational study of 126 patients. J Laparoendosc Adv Surg Tech A. 2014 Feb;24(2):60-5"

use the umbelical hernia defect for camera port by open technique,do an anatomical repair after cholecystectomy.If the hernia defect is large,use 5mm supraumbelical port for the camera and do a standard mesh hernia repair.We have done both techniques and there is slight imcrease in incidence of recurrence in the former.

sorry,since already mesh repair was done for umbelical hernia,primary port through the epigatrium is preferable.Avoid removing the specimen through the same port to prevent chances of infection and further recurrence.

For first time umbilical hernia which is small: this can be used as the first trocar insertion for the camera and simple anatomical suture repair is done at the end.

For larger and recurrent hernia: I remove the gallbladder only and do the hernia at another time preferably laparoscopically. 

The decision depends on with what symptoms / problem the patient has come with , whether the gall stones are symptomatic, what kind of repair (lap / open) was done previously, co morbid conditions , patient performance status and age. If the early intervention for gall stones is the decision after above factors, would do lap cholecystectomy while placing posts away from the hernial site. I would take recurrence of hernia after mesh repair more seriously. Has to be dealt with utmost care irrespective of the method , must give due attention to minimising recurrence and sepsis . Most probably would plan separately unless the symptoms are due to this hernia, in which case this becomes a priority to gall stones.

What an interesting question.Good to see this on my feed.I'm trying to imagine it but the comments somehow made it clear.It never crossed my mind.It was good to read some comments here so that I can learn some various surgical procedures and other stuffs.So many things that I need to learn.I will definitely read some when I do have spare time.Thanks for this question.