Trends and Prevalence of Surgical Methods in Umbilical Hernia Repairs in Sweden: A Nationwide Population-Based Registry Cohort Study.

Abstract

<h4>Background</h4>Umbilical hernia repairs (UHRs) are commonly performed worldwide, yet knowledge regarding methods of repair remains limited. This study aimed to assess the trends and prevalence of suture versus mesh repairs for UHRs in Sweden over time.<h4>Methods</h4>This observational population-based registry study utilised prospectively collected data from the nationwide Swedish Perioperative Registry. Patients aged ≥18 who received a UHR between the years 2017-2022 were eligible. Surgical units were categorised into six healthcare regions. The primary outcome was to observe the trend in repair methods (suture vs. mesh) over time. The secondary outcome included descriptive patient- and hernia characteristics of the UHRs, along with regional variations.<h4>Results</h4>Out of 10,374 primary elective UHRs, mesh was used in 47.9% of cases, with 14.2% performed laparoscopically. Mesh repairs were less common in women (38.7%) compared to men (52.1%) (p < 0.001). Suture repair patients had a lower median age (49 years) and BMI (27.2 kg/m²) compared to those with mesh repairs (55 years, BMI 29.7 kg/m²) (p < 0.001). A higher ASA class (3-4) was more common for mesh repair recipients (17.1%) compared to suture repair recipients (10.9%). The use of mesh repairs increased from 46.2% to 49.4% over the study period (p = 0.063), with only the Southern healthcare region showing a significant rise from 25.0% to 56.1% (p < 0.001).<h4>Conclusion</h4>The use of mesh repairs has not yet significantly influenced UHR practices in Sweden. Mesh was used more frequently among men, obese patients, older individuals, and those with greater co-morbidities.