Many patients with an inguinal hernia are asymptomatic or have little in the way of symptoms from their hernia.
Repair is often associated with long-term chronic pain and has a recurrence rate of 5% to 10%.
Dr Patrick O'Dwyer and colleagues compared operation with a wait-and-see policy in patients with an asymptomatic hernia.
A total of 160 male patients 55 years or older were randomly assigned to observation or operation.
The team of doctors assessed patients clinically, and sent questionnaires at 6 months and 1 year.
The primary endpoint was pain and general health status at 12 months.
Other outcome measures included costs to the health service and the rate of operation for a new symptom or complication.
At 12 months, the doctors found no significant differences between the randomized groups of observation or operation.
|3 hernia-related adverse events occured with observation vs none in the operation group|
|Annals of Surgery|
The team also observed no difference between the 2 groups in visual analogue pain scores at rest, at 4 mm versus 5 mm, respectively.
No significant difference was noted in visual analogue pain scores on moving, which scored 8 mm versus 6 mm in the observation and operation groups, respectively.
Also, the doctors found that the number of patients who recorded pain on moving and the number taking regular analgesia, was similar at 9 versus 17.
At 6 months, there were significant improvements in most of the dimensions of the Short Form-36 for the operation group.
However, at 12 months the doctors noted that the trend remained the same.
The differences were only significant for change in health.
The team of doctors identified that the rate of crossover from observation to operation 23 patients at a median follow-up of 574 days was higher than predicted.
The observation group also suffered 3 serious hernia-related adverse events compared with none in the operation group.
Dr O'Dwyer's team concludes, “Repair of an asymptomatic inguinal hernia does not affect the rate of long-term chronic pain, and may be beneficial to patients in improving overall health and reducing potentially serious morbidity.”