Is surgical repair of an asymptomatic groin hernia appropriate? A review
- 803 Downloads
Groin herniorrhaphy is the most common operation performed by general surgeons. Annually, more than 20 million groin hernias are repaired worldwide. The general approach towards groin hernias is surgical repair regardless of the presence of symptoms. The rationale to recommend surgery for asymptomatic groin hernias is prevention of visceral strangulation. The goal of this review is to evaluate the appropriateness of surgery in patients with asymptomatic groin hernias.
The review was based on an extensive literature search of Pubmed, Medline and the Cochrane Library.
The risk of incarceration is approximately 4 per 1,000 patients with a groin hernia per year. Risk factors for incarceration are age above 60 years, femoral hernia site and duration of signs less than 3 months. Morbidity and mortality rates of emergency groin hernia repair are higher in patients who are older than 49 years, have a delay between onset of symptoms and surgery of more than 12 h, have a femoral hernia, have nonviable bowel and have an ASA-class of 3 or 4. The recurrence rate after tension-free mesh repair in the management of emergency groin hernias is comparable to that of elective repair. There is no difference in pain and quality of life after elective repair compared to watchful waiting. There is no advantage in cost-effectiveness of elective repair compared to watchful waiting.
Watchful waiting for asymptomatic groin hernias is a safe and cost-effective modality in patients who are under 50 years old, have an ASA class of 1 or 2, an inguinal hernia, and a duration of signs of more than 3 months.
KeywordsInguinal Hernia Asymptomatic Therapy
- 2.Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83(5):1045–1051, v–viGoogle Scholar
- 20.McCormack K, Scott N, Go PMNYH, Ross SJ, Grant A, Collaboration the EU Hernia Trialists (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 1. Art. No.:CD001785. doi: 10.1002/14651858.CD001785
- 29.Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM (2002) Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev 4. Art. No.:CD002197. doi: 10.1002/14651858.CD002197
- 34.Lewis DC, Moran CG, Vellacott KD (1989) Inguinal hernia repair in the elderly. J R Coll Surg Edinburgh 34(2):101–103Google Scholar
- 51.O’Riordan DC, Kingsnorth AN (1998) Audit of patient outcomes after herniorrhaphy. Surg Clin North Am 78(6):1129–1139, viii–ixGoogle Scholar
- 57.Askew G, Williams GT, Brown SC (1992) Delay in presentation and misdiagnosis of strangulated hernia: prospective study. J R Coll Surg Edinburgh 37(1):37–38Google Scholar