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Surgery vs. Observation of Inguinal Hernias

More support for a strategy of watchful waiting for minimally symptomatic cases

Two studies in the Annals of Surgery bear on the decision whether to repair minimally symptomatic inguinal hernias.

Scottish surgeons randomized 160 men (age, 55) with asymptomatic inguinal hernias to undergo surgery (tension-free mesh repair) or observation. During 1 year of follow-up, 20% of observation patients crossed over to surgery. In intent-to-treat analyses conducted at 1 year, no difference in pain was noted between the groups, and a borderline-significant improvement in general health status (according to the SF-36 scale) was found in the surgery group but not in the observation group. One observation patient required emergency surgery, and one surgery patient had a fatal postoperative myocardial infarction.

Swedish researchers used a national registry to estimate the prevalence of pain after inguinal hernia surgery: In early 2003, they sent questionnaires to nearly 3000 randomly selected patients (93% men) who had undergone surgery during the year 2000; 86% responded. Thirty-one percent of respondents reported at least some pain during the previous week at the site of the hernia repair, and 6% reported that the pain interfered with their concentration or performance of daily activities.

Comment: Taken together, these findings support the results of a large, recently published randomized trial in which watchful waiting was shown to be a reasonable approach for men with minimally symptomatic inguinal hernias (Journal Watch Jan 31 2006). Emergency surgery is needed only rarely, and a substantial minority of patients have persistent inguinal discomfort for at least several years after surgery.

— Allan S. Brett, MD

Published in Journal Watch General Medicine August 29, 2006

Citation(s):

O'Dwyer PJ et al. Observation or operation for patients with an asymptomatic inguinal hernia: A randomized clinical trial. Ann Surg 2006 Aug; 244:167-73.

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Fränneby U et al. Risk factors for long-term pain after hernia surgery. Ann Surg 2006 Aug; 244:212-9.

• Medline abstract (Free)