The Usefulness of the New EHS/AHS Classification of Primary Umbilical Hernias in the Selection of the Method of Their Treatment

Introduction: Umbilical hernias occur in approximately 2% of the population. The latest 2020 guidelines, due to changes in classification, recommend mesh implantation when the wall defect is larger than 1 cm, instead of 2 cm as the 2009 classification. A significant number of surgeons still perform umbilical hernia repairs according to the older classification.Aim: The aim of this study is to evaluate the usefulness of the new classification of primary umbilical hernias in determining the appropriate treatment method for patients.Material and method: A retrospective analysis was conducted on 1087 patients who underwent surgery in a single department between January 2016 and December 2022. Data were collected from an electronic database, including gender, age, comorbidities, body weight, duration of surgery, hernia size, and methods of treatment. The follow-up period ranged from over 1 to 7 years. Recurrence rates were assessed based on outpatient records and a phone survey. Hernias were classified according to the EHS/AHS guidelines as small, medium, and large. Both the old and new classification systems for hernias were used in the assessment. A detailed analysis was performed on hernias with a defect size of 1-2 cm, for which the EHS/AHS guidelines have changed their recommendations. The study was approved by the ethics committee and registered at ClinicalTrials.gov (ID NCT06530420).Results: The largest group of primary umbilical hernias consisted of small hernias. In over 90% of these cases, the defect was repaired using simple sutures. Hernias with a defect size of 1-2 cm were predominantly treated with sutures as well. Mesh implantation was associated with a higher rate of postoperative complications, such as hematomas and infections at the surgical site. No significant difference in the recurrence rate of 1-2 cm hernias was observed based on the method of treatment.Conclusions: The change in the EHS/AHS classification, and consequently the recommendations regarding treatment for hernias with wall defects of 1-2 cm, was not justified in the analyzed patient sample. Based on the results of our analysis, we conclude that the choice of treatment method for hernias with wall defects up to 2 cm should depend on the clinical situation and the surgeon’s experience.