Watchful Waiting as a Treatment Strategy in Patients with Asymptomatic Inguinal Hernia
An inguinal hernia is one of the most common diseases known to mankind, and inguinal herniorrhaphy is the most commonly performed general surgical procedure in the world. Approximately one-third of these inguinal hernias are asymptomatic or minimally symptomatic. These asymptomatic hernias have historically been treated surgically due to the fear of complications such as strangulation or bowel obstruction. This concept has been challenged in the last 10 years based on two randomized, controlled trials that have compared a strategy of watchful waiting (WW) for asymptomatic or minimally symptomatic inguinal hernias to routine repair. Initial results from both studies demonstrated no significant increase in emergency hernia surgery in the group that underwent WW. However, in the long-term analysis, it was found, by both groups independently, that eventually the majority in the watchful waiting group would cross over to surgery due to progression of symptoms, most commonly pain and discomfort.
KeywordsInguinal hernia Asymptomatic Minimally symptomatic Watchful waiting
- 1.Fitzgibbons, R. J.,Jr, Ramanan, B., Arya, S., Turner, S. A., Li, X., Gibbs, J. O., Investigators of the Original Trial. Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg. 2013;258(3):508–15. https://doi.org/10.1097/SLA.0b013e3182a19725 [doi].CrossRefPubMedGoogle Scholar
- 7.O’Dwyer PJ, Norrie J, Alani A, Walker A, Duffy F, Horgan P. Observation or operation for patients with an asymptomatic inguinal hernia: a randomized clinical trial. Ann Surg. 2006;244(2):167–73. https://doi.org/10.1097/01.sla.0000217637.69699.ef.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia : J Hernias Abdom Wall Surg. 2011;15(3):239–49. https://doi.org/10.1007/s10029-011-0798-9 [doi].CrossRefGoogle Scholar