NEW YORK (Reuters Health) - For hernias that aren’t painful, choosing watchful waiting instead of immediate surgery isn’t tied to any long-term health problems, suggests a new report.
Still, many patients who took a wait-and-see approach with the groin bulges ended up eventually getting surgery when their hernias grew too big or started causing pain.
“The most important thing is, they don’t seem to suffer a penalty for waiting,” said Dr. Robert Fitzgibbons, a surgeon from Creighton University School of Medicine in Omaha, Nebraska.
“It was always thought that the longer you wait, the harder it gets to repair the hernia,” said Fitzgibbons, a hernia researcher who wasn’t involved in the new report. “But that doesn’t seem to be the case.”
Reviewers combined past results from two research teams -- including one led by Fitzgibbons -- who compared short- and long-term outcomes in men with symptom-free hernias who were randomly assigned to get surgery right away or take a more conservative approach.
Though women can also get groin hernias, they’re much more common in men.
The data came from studies of about 1,700 men, generally followed for at least a year or two after their initial treatment, or lack thereof.
Co-authors Dr. Hagar Mizrahi and Michael Parker from Darent Valley Hospital in Kent, UK, found that regardless of the initial hernia management strategy, men reported similar amounts of pain, including pain interfering with daily activities, and similar general health over the long run.
Depending on the study, between one-quarter and three-quarters of men who didn’t initially get elective surgery ultimately ended up having their hernias repaired when the pain got worse or the bulges got too big.
Less than one percent of men in the watchful waiting groups were treated for hernias that cut off the blood supply to organs -- one of the main risks of putting off surgery, which calls for an emergency repair procedure.
The chance of hernias coming back after repairs was also low, affecting about two percent of men who went the surgery route, the researchers reported in the Archives of Surgery.
Fitzgibbons told Reuters Health that groin hernias won’t go away in patients who choose watchful waiting -- but they might never get any worse.
“Hernia (removal) tends to be a painful operation,” he said. “The main advantage of delaying is that you might permanently avoid this painful operation.”
The procedure also comes with a risk of complications, Mizrahi pointed out, such as infections and chronic pain -- which might be more worrisome in some patients than others.
“Watchful waiting should be considered, in my opinion, in cases of patients who suffer other illnesses such as cardiac or pulmonary disease in whom anesthesia might be more unsafe and the consequences of surgery might worsen their general condition,” Mizrahi, also from the Haemek Medical Center if Afula, Israel, told Reuters Health in an email.
“One should consider carefully when having an operation which might cause complications for an asymptomatic disease.”
For groin hernia repair, a less-invasive approach led to a faster return to daily activities and higher patient satisfaction, along with fewer hernia recurrences -- especially when the procedures were done by experienced surgeons, in another study published in the same journal.
People should know first and foremost that they have choices if their hernia isn’t causing them any problems, Fitzgibbons said.
“They can be reassured that watchful waiting is a reasonable option for them,” he concluded. SOURCES: and Archives of Surgery, online March 19, 2012.
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