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What is the reality in epigastric hernia repair?–a trend analysis from the Herniamed Registry



The proportion of epigastric hernias in the total collective of all operated abdominal wall hernias is 3.6–6.9%. The recently published guidelines for treatment of epigastric hernias of the European Hernia Society and the Americas Hernia Society recommend the use of a mesh for defect size of ≥ 1 cm, i.e., a preperitoneal flat mesh technique for sizes 1–4 cm, and laparoscopic IPOM technique for defects > 4 cm and/or obesity. Against that background, this analysis of data from the Herniamed Registry now aims to explore trends in epigastric hernia repair.


To detect trends, the perioperative outcome was calculated separately for the years 2010 to 2019 and the 1-year follow-up for the years 2010 to 2018 and significant differences were identified. Analysis was based on 25,518 primary elective epigastric hernia repairs. The rates of postoperative surgical complications, pain at rest, pain on exertion, chronic pain requiring treatment and recurrence associated with the various surgical techniques were calculated separately for each year. Fisher’s exact test for unadjusted analysis between years was applied with Bonferroni adjustment for multiple testing.


The proportion of laparoscopic IPOM repairs declined from 26.0% in 2013 to 18.2% in 2019 (p < 0.001). Instead, the proportion of open sublay repairs rose from 16.5% to 21.8% (p < 0.001). That was also true for innovative techniques such as the EMILOS, MILOS, eTEP and preperitoneal flat mesh technique (8.3% vs 15.3%; p < 0.001). This change in indication for the various surgical techniques led to a significant improvement in the postoperative surgical complication rate (3.8% vs 1.9%; p < 0.001).


The trend is for epigastric hernia repair to be performed less often in laparoscopic IPOM technique and instead more often in open sublay technique or the new innovative techniques.

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  1. Fitzgibbons, Jr. RJ (2002) Greenburg AG 35B Epigastric Hernia; Page 398–404 in: Nyhus & Condon’s-Hernia, Fifth Edition by Lippincott Williams & Wilkins

  2. Ponten JEH, Thomassen I (2014) Nienhuijs SW A Collective Review on Mesh-Based Repair of Umbilical and Epigastric Hernias. Indian J Surg 76:371–377.

    Article  PubMed  Google Scholar 

  3. Statistisches Bundesamt (Destatis) (2019) Artikelnummer: 5231401197014

  4. Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am. 83:1045–1051.

    Article  PubMed  Google Scholar 

  5. Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T (2013) Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study. World J Surg 37:2273–2279.

    Article  PubMed  Google Scholar 

  6. Ponten JE, Somers KY, Nienhuijs SW (2012) Pathogenesis of the epigastric hernia. Hernia 16:627–633.

    CAS  Article  PubMed  Google Scholar 

  7. Blonk L, Civil YA, Kaufmann R, Ket JC, van der Velde S (2019) A systematic review on surgical treatment of primary epigastric hernias. Hernia 23:847–857.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Ponten JE, Leenders BJ, Leclercq WK, Lettinga T, Heemskerk J, Konsten JL, Castelijns PS, Nienhuijs SW (2018) Mesh versus patch repair for epigastric and Umbilical Hernia (MORPHEUS Trial); one-year results of a randomized controlled trial. World J Surg. 42:1312–1320.

    CAS  Article  PubMed  Google Scholar 

  9. Ponten JEH, Leclercq WKG, Lettinga T, Heemskerk J, Konsten JLM, Bouvy ND, Nienhuijs SW (2019) Mesh OR patch for hernia on epigastric and Umbilical sites (MORPHEUS-Trial): the complete two-year follow-up. Ann Surg. 270:33–37.

    Article  PubMed  Google Scholar 

  10. Bernardi K, Olavarria OA, Holihan JL, Kao LS, Ko TC, Roth JS, Tsuda S, Vaziri K, Liang MK (2020) Primary fascial closure during laparoscopic ventral hernia repair improves patient quality of life: a multicentre, blinded randomized controlled trial. Ann Surg 271:434–439.

    Article  PubMed  Google Scholar 

  11. Henriksen NA, Montgomery A, Kaufmann R, Berrevoet E, East B, Fischer J et al (2020) Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. BJs 107:171–190.

    CAS  Article  Google Scholar 

  12. Stechemesser B, Jacob DA, Schug-Pass C (2012) Köckerling Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16:269–276.

    CAS  Article  PubMed  Google Scholar 

  13. Kyle-Leinhase I, Köckerling F, Jorgensen LN, Montgomery A, Gillion JF, Rodriguez JAP, Hope W, Muysoms F (2018) Comparison of hernia registries: the CORE project. Hernia 22:561–575.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. Köckerling F, Brunner W, Fortelny R, Mayer F, Adolf D, Niebuhr H, Lorenz R, Reinpold W, Zarras K, Weyhe D (2020) Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry. Hernia.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault DD, Chelala E et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. Ponten JE, Leenders BJ, Charbon JA, Nienhuijs SW (2015) A consecutive series of 235 epigastric hernias. Hernia 19:821–825.

    CAS  Article  PubMed  Google Scholar 

  17. Köckerling F, Hoffmann H, Mayer F, Zarras K, Reinpold W, Fortelny R, Weyhe D, Lammers B, Adolf D, Schug-Pass C (2020) What are the trends in incisional hernia repair?–Real-world data over 10 years from the Herniamed Registry. Hernia.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sharma A (2018) Berger D The current role of laparoscopic IPOM repair in abdominal wall reconstruction. Hernia 22:739–741.

    CAS  Article  PubMed  Google Scholar 

  19. Muysoms F (2018) IPOM: history of an acronym. Hernia 22:743–746.

    CAS  Article  PubMed  Google Scholar 

  20. Christoffersen MW, Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T (2013) Lower reoperation rate for recurrence after mesh versus sutured elective repair in small Umbilical and Epigastric Hernias A Nationwide Registry Study. World J Surg 37:2548–2552.

    CAS  Article  PubMed  Google Scholar 

  21. Christoffersen MW, Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P (2015) Bisgaard T Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study. Am J Surgery 209:725–732.

    Article  Google Scholar 

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Correspondence to F. Köckerling.

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Conflict of interest

Dr. Köckerling reports grants from Johnson & Johnson, Norderstedt, grants from Karl Storz, Tuttlingen, grants from pfm medical, Cologne, grants from Dahlhausen, Cologne, grants from B Braun, Tuttlingen, grants from MenkeMed, Munich, grants from Bard, Karlsruhe, during the conduct of the study; personal fees from Bard, Karlsruhe, outside the submitted work. All other authors have nothing to disclose.

Ethical approval

As only cases of routine hernia surgery are documented in the Herniamed Registry, an ethical approval was not neccessary.

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This article does not contain any study with animals performed by any of the authors.

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All patients with routine hernia surgery documented in the Herniamed Registry have signed an informed consent declaration agreeing to participate.

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Köckerling, F., Adolf, D., Zarras, K. et al. What is the reality in epigastric hernia repair?–a trend analysis from the Herniamed Registry. Hernia 25, 1083–1094 (2021).

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  • Epigastric hernia
  • Guidelines
  • Perioperative complications
  • Recurrence
  • Chronic pain