High Prevalence of Cholelithiasis in Umbilical Hernia Patients and Vice Versa: A Prospective Multicenter Study

Background Cholelithiasis (CL) and umbilical hernia (UH) often coexist, but their exact relationship remains underexplored. Both conditions share common risk factors such as obesity, female gender, and metabolic disorders, suggesting a potential pathophysiological link. Despite numerous retrospective analyses, robust prospective multicenter data are lacking. This study aims to provide a more accurate estimation of the prevalence of UH in CL patients and vice versa, identify independent risk factors, and assess the predictive value of BMI in this association. Methods In this prospective, multicenter, cross-sectional study, 278 adult patients presenting with either CL or UH were enrolled across four tertiary medical centers between October 2023 and September 2024. Participants were categorized into CL and UH groups based on clinical and radiological assessments. Demographics, clinical characteristics, and comorbidities were carefully analyzed. Multivariate logistic regression identified independent risk factors, while receiver operating characteristic (ROC) curve analysis determined optimal BMI thresholds predictive of CL and UH. Results A total of 44 (25.9%) patients with CL had UH, while 32 (29.6%) patients with UH had CL. Multivariate analysis revealed female gender (OR: 0.221, 95% CI: 0.068-0.724, p = 0.013) and obesity (BMI ≥ 30 kg/m², OR: 3.443, 95% CI: 1.337-8.886, p = 0.001) as significant independent risk factors. ROC analysis identified a BMI cut-off of 26.5 kg/m² for predicting CL in UH patients (AUC: 0.679, p = 0.001) and 28.8 kg/m² for predicting UH in CL patients (AUC: 0.748, p < 0.001). Conclusion The observed co-prevalence of CL and UH suggests a potential association that may warrant further clinical attention in carefully evaluated cases. Ultrasound screening for cholelithiasis may be considered in umbilical hernia patients with elevated BMI or other risk factors, as it may assist in surgical planning and help avoid intraoperative difficulties related to adhesions during possible future cholecystectomy. These findings suggest a potentially meaningful clinical association and support the need for further investigation into shared pathophysiological mechanisms.