Introduction. Anterior abdominal wall hernias remain one of the most prevalent surgical conditions, imposing substantial organizational and resource demands on the healthcare system. Monitoring regional incidence trends is essential for surgical care planning. Purpose of the study: To analyze the dynamics of primary and overall incidence of anterior abdominal wall hernias across the regions of the Northwestern Federal District (NWFD) for the period 2021–2024 Materials and methods. The study utilized data from Federal Statistical Reporting Form No. 12 "Information on the Number of Diseases Registered in Patients Residing in the Service Area of a Medical Organization" for the Russian Federation, the NWFD, and its 11 constituent regions for 2021–2024. Descriptive statistics, linear regression analysis, and growth rate estimation methods were applied. Results and discussion. In the NWFD, the overall incidence of anterior abdominal wall hernias increased from 443.4 to 556.0 per 100,000 population (a 25.4% increase), while primary incidence rose from 109.8 to 146.4 (a 33.4% increase). Both indicators exceeded the national averages. The Kaliningrad Oblast demonstrated the most pronounced dynamics: overall incidence in the region increased from 307.9 to 542.2 per 100,000 population (+76.1%; mean annual growth rate (MAGR) = +20.8%), compared to a 25.4% increase in the NWFD (MAGR = +7.8%) and 19.9% in the Russian Federation (MAGR = +6.2%). By primary incidence, the region ranked first in the NWFD by the end of 2024. The rapid increase in primary morbidity combined with a marked increase in overall morbidity indicates both a real increase in the number of newly diagnosed cases and an improvement in diagnostic activity in relation to this group of patients. Conclusions. A sustained upward trend in the incidence of anterior abdominal wall hernias was identified in the NWFD, against a background of considerable interregional variability. The growing burden of anterior abdominal wall hernias underscores the need to improve the healthcare delivery system for this patient population and to develop tools for monitoring the quality of surgical care provided to this category of patients.