Inguinal hernias (hernias in the groin) are common, and more than 600,000 hernia repair procedures are performed in the US each year. Most hernias are diagnosed after a patient complains of groin pain or discomfort, but some hernias are found upon physical exam and are accompanied with few or no symptoms. When deciding how to treat these minimally symptomatic hernias, patients and their physicians must choose between delaying surgery until symptoms worsen and risking hernia-related complications or repairing the hernia surgically and risking surgery-related complications. Until now, few studies have compared these treatment options.
In a new study in the January 18, 2006 issue of the Journal of the American Medical Association, researchers sought to compare the safety and effectiveness of hernia repair surgery with watchful waiting—a strategy of delaying surgery until symptoms develop or worsen, if they ever do. Researchers found that watchful waiting was as effective as hernia repair surgery in men with minimally symptomatic inguinal hernias, and resulted in fewer complications.
This study included 720 men who had an inguinal hernia with few or no symptoms. The men were randomly assigned to a watchful waiting treatment strategy or to receive hernia repair surgery. The researchers followed the participants for an average of three years, tracking pain and complications.
There was no significant difference in the proportion of participants reporting pain interfering with activities between the watchful waiting and surgery groups (5.1% and 2.2%, respectively). Both groups showed improvement in physical functioning after two years, with no difference between the groups. Twenty-two percent of participants in the surgery group experienced complications (e.g., bleeding, infection), and three (1%) experienced life-threatening complications (e.g., blood clot). Only two (0.5%) of the participants in the watchful waiting group experienced hernia-related complications (e.g., abdominal contents trapped in the hernia).
After two years, 23% of the men in the watchful waiting group had elected to have surgical repair. The most common reason for this was increased pain.
While these results are certainly compelling, long-term risks of the treatment options could not be determined, since the average study follow up was only about three years.
The results of this study strongly suggest that watchful waiting is a safe and reasonable approach for people who have inguinal hernias with few or no symptoms. Physicians can now turn to this evidence with some confidence when discussing the risks and benefits of hernia treatment options with their patients.
If you have an inguinal hernia that is not interfering with your daily life, ask your physician whether a watchful waiting treatment strategy would be appropriate for you. You may be able to postpone surgery as long as your hernia does not become uncomfortable. But keep in mind that if you choose to hold off, there is a reasonable chance (nearly one in four after two years in this study) that you will end up electing to have a surgical repair at some point in the near future.
RESOURCES:
American College of Surgeons
http://www.facs.org/
National Institute of Diabetes and Digestive and Kidney Diseases
http://digestive.niddk.nih.gov/
References:
Fitzgibbons RJ, Giobbie-Hurder A, Gibbs JO. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA. 2006;295(3):285-292.
Flum DR. The asymptomatic hernia: “If it’s not broken, don’t fix it.” JAMA. 2006;295(3):328-329.
Last reviewed Jan 19, 2006 by Richard Glickman-Simon, MD
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