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Inguinal Hernias: To Repair or Not to Repair?

Watchful waiting and immediate repair were equally acceptable in minimally symptomatic patients.

Many physicians and patients wonder if repair of minimally symptomatic inguinal hernias is always necessary. In this multicenter North American trial, researchers randomized 724 men (mean age, 58) to watchful waiting (WW) with follow-up at 6, 12, and 24 months or to tension-free open hernia repair (with postoperative follow-up as needed) plus follow-up at 6, 12, and 24 months. Sixty-two patients (17%) who were randomized to repair crossed over to WW, most often by patient request; 85 (23%) who were randomized to WW crossed over to surgical repair, most often because of increasing pain.

In analyses based either on the original randomization assignment or on the eventual treatment, no between-group differences were found in substantial pain (interfering with activities) or in the physical component of a standardized functional assessment. Patients assigned to WW who crossed over to surgery improved more than those who were assigned to surgery initially. Two WW patients had hernia incarcerations that required intervention (1.8 events/1000 patient-years).

Comment: These data support a strategy of presenting middle-aged or older patients who have minimally symptomatic inguinal hernias with a choice of repair or watchful waiting. Risks associated with WW are low (although they might increase with longer follow-up), and outcomes are equivalent. Those patients who initially defer surgery and then undergo later repair due to increased symptoms also do well.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine January 31, 2006

Citation(s):

Fitzgibbons RJ Jr et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: A randomized clinical trial. JAMA 2006 Jan 18; 295:285-92.

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