Patients’ motivation for undergoing elective repair of a primary ventral hernia: a Danish nationwide cohort study

PURPOSE: This study aimed to explore patient motivations for undergoing elective repair of a primary ventral hernia and to estimate the proportion of patients who underwent surgery for indications that are not traditionally prioritized in surgical decision-making. METHODS: This descriptive mixed-methods study was based on a nationwide survey of Danish patients who had undergone elective repair of an umbilical or epigastric hernia between 2014 and 2024. Data were collected through structured survey questions on predefined motivational factors and linked to national clinical registries. Qualitative free-text responses were analyzed using systematic text condensation to provide contextual understanding of patient motivations. The study forms part of the AFTERHERNIA Project, a series of nationwide studies investigating patient-reported outcomes after groin and ventral hernia surgery in Denmark. RESULTS: A total of 18,753 participants completed the survey, corresponding to a response rate of 82%. The most frequently reported motivations for surgery were pain or discomfort (63%), concerns about hernia growth (39%), and doctors’ recommendations (34%). 12% of participants selected only reasons classified as motivations that are not traditionally prioritized in surgical decision-making. (cosmetic concerns, fear of growth, fear of incarceration, or emotional impact). The qualitative analysis supported these findings, identifying seven themes that reflected symptom burden, professional guidance, and contextual or practical factors as key drivers of patient decision-making. CONCLUSION: About one in eight patients underwent elective repair of a primary ventral hernia motivated by indications that are not traditionally prioritized in surgical decision-making. However, most respondents were motivated by physical symptoms or professional advice.