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News

Delayed surgical repair for acute inguinal hernia is safe

JAMA finds that watchful waiting is acceptable for men with minimally symptomatic inguinal hernias; delayed surgical repair until symptoms increase is safe because acute hernia incarcerations occur rarely.

News image

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Many men with inguinal hernia have minimal symptoms.

Whether deferring surgical repair is a safe and acceptable option has not been assessed.

Dr Robert Fitzgibbons and colleagues conducted a randomized trial in 720 men with minimally symptomatic inguinal hernias from 1999 to 2004.

The investigative team compared pain and the physical component score of the Short Form-36 Version 2 survey at 2 years.

The team reported that 364 patients were treated with watchful waiting, and 356 with surgical repair at 5 North American Centers.

The watchful-waiting patients were followed up at 6 months and annually, and were observed for hernia symptoms.

The repair patients received standard open tension-free repair and were followed up at 3 and 6 months, and annually.

1 watchful-waiting patient had acute hernia incarceration without strangulation
Journal of the American Medical Association

The main outcomes included pain and discomfort interfering with usual activities at 2 years, and change in physical component score from baseline to 2 years.

The team's secondary outcomes were complications, patient-reported pain, functional status, activity levels, and satisfaction with care.

The researchers' primary intention-to-treat outcomes, such as pain limiting activities, were similar at 2 years for watchful waiting vs surgical repair.

The team noted that 23 % assigned to watchful waiting crossed over to receive surgical repair.

Increase in hernia-related pain was the most common reason offered for this cross-over.

The researchers observed that 17% assigned to receive repair crossed over to watchful waiting.

Self-reported pain in watchful-waiting patients crossing over improved after repair.

The occurrence of postoperative hernia-related complications was similar in patients receiving repair as assigned, and in patients who crossed over treatment.

The team noted that 1 watchful-waiting patient experienced acute hernia incarceration without strangulation within 2 years.

A further patient had acute incarceration with bowel obstruction at 4 years, with a frequency of 2 in 1000 patient-years in patients followed up for 5 years.

Dr Fitzgibbons' team commented, “Watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias.”

“Delaying surgical repair until symptoms increase is safe because acute hernia incarcerations occur rarely.”

http://jama.ama-assn.org/cgi/content/abstract/295/3/285
26 January 2006

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