Abdominal wall hernias are fairly common, affecting 1.7 percent of people of all ages and 4 percent of people 45 and older. Inguinal hernias make up 75 percent of abdominal wall hernias and disproportionately affect men more so than women. Surgery to repair an inguinal hernia is one of the most common types of surgeries performed in the United States, and while it has been widely accepted that surgery is the most appropriate treatment for an inguinal hernia, new research suggests there may be an alternative option to surgery.
A new trial suggests that “watchful waiting” in men who are mildly symptomatic or asymptomatic is a “valid alternative to immediate surgery.” Dutch researchers randomized 496 men with inguinal hernias who had no or mild symptoms to either undergo surgery or be observed through “watchful waiting.” When looking at both of these groups 3 years out, their level of pain “changed minimally,” with only a small difference favoring those who had surgery. Among the watchful waiting patients, 35 percent ended up having elective surgery while “2.3 percent required emergency surgery for incarceration or strangulation.”
Follow-up at 7 to 10 years found that two-thirds of the men observed had an elective surgery and 2 percent required emergency surgery.
Surgery is still an effective option for inguinal hernias in men who have pain, but watchful waiting is becoming a more widely accepted alternative option for those who are asymptomatic or who have only mild pain or discomfort.
Jeremiah Robinson PA-C is a licensed and certified Physician Assistant with T. Douglas Gurley MD in Atlanta, GA