Waiting To Repair Inguinal Hernias

From Journal Watch:

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).

Whoever is coming up with this research has never seen a patient need a bowel resection from a strangulated hernia. This avenue of research is dangerous, and shouldn't be used to justify holding off elective surgery for inguinal hernias in healthier patients in my opinion.


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