Recurrence and chronic pain comparing mesh versus suture repair for smaller umbilical hernias in adults: the randomised clinical SUMMER trial

Abstract Introduction Umbilical hernia repair is among the most common surgical procedures worldwide and yet evidence is limited on whether to use mesh or suture repair for smaller umbilical hernias. This study presents the 1-year outcomes from a randomized clinical trial comparing mesh and suture repair for smaller umbilical hernias. Method A multicenter, double-blind, randomized controlled trial was conducted across six surgical units in Sweden to compare a 4×4 cm onlay-mesh repair with conventional suture repair for primary elective umbilical hernias ≤ 2 cm. The primary outcome is recurrence at 1 and 3 years. Secondary outcomes included surgical site complications and pain intensity 30 days post-surgery (previously reported), alongside chronic pain assessment via the Ventral-Hernia-Pain-Questionnaire 1-year post-surgery. Result Between 2020-2024, totally 290 participants were randomly assigned to either suture (n=146) or mesh repair (n=144). Intention-to-treat (ITT) population and completed cases (CC) were analyzed at one year. Recurrence rate was 5.9% (8/136) for suture repairs versus 2.3% (3/128) for mesh repairs. Chronic pain was reported in 5.4% (7/130) of the suture group compared to 2.4% (3/125) in the mesh group. Logistic regression analysis revealed non-significant reduced odds ratios for both recurrence (ITT: 0.51, CI95% 0.14-1.85, CC: 0.37, CI95% 0.08-1.33) and chronic pain (ITT: 0.48, CI95% 0.13-1.79, CC: 0.41, CI95% 0.09-1.54) with mesh repairs. Discussion This trial provides high-level evidence favoring mesh repair as a preferred method for smaller umbilical hernias, indicating less chronic pain and a trend towards lower recurrence rates compared to suture repair. Follow-up at 3 years will further clarify differences in recurrence.