Outcomes/Effectiveness Research

Delaying repair of an asymptomatic hernia does not adversely affect the patient

Delaying surgical repair of an asymptomatic or minimally symptomatic hernia (cases with no limitation of usual activities by hernia-related pain or discomfort) does not adversely affect the patient, concludes a new study. Hernias are portions of the intestine or abdominal fatty tissue that bulge out of the groin area. They are often painless, but can be tender, painful, and swollen.

In this study, watchful waiting for hernias causing minimal symptoms did not make later surgery more difficult. In addition, postoperative complications, hernia recurrence rates, and patient-reported outcomes with delayed surgery were no worse than for surgical repair within 6 months, note the researchers. They compared 353 similar patients with minimally symptomatic inguinal hernias from a multicenter randomized clinical trial. Overall, 288 patients had immediate hernia repair within 6 months of study entry, and 65 patients had their surgery delayed for more than 6 months.

There was no difference in operative time and rate of complications within 30 days of surgery between the two groups. Recurrence of the hernia occurred in five (1.4 percent) of all the patients, with differences between the two groups insignificant. However, given the small sample size and short follow-up, these recurrence rates should be interpreted with caution, note the researchers.

Pain scores did seem higher before surgery for the delayed-repair group, but there were no significant differences in pain scale dimensions between the two groups after surgery. Nearly all patients indicated satisfaction with their hernia care (99 percent in the immediate repair group and 98.5 percent in the delayed repair group) as well as the results of that care (97.9 and 93.9 percent, respectively).

The researchers previously found a low risk of hernia accident (intestinal obstruction or strangulation) with delayed surgical repair. This further strengthens the argument that watchful waiting is a safe and reasonable strategy for patients with minimal or asymptomatic inguinal hernias. The study was supported in part by the Agency for Healthcare Research and Quality (HS09860).

See "Does delaying repair of an asymptomatic hernia have a penalty?" by Jon S. Thompson, M.D., James O. Gibbs, Ph.D., Domenic J. Reda, Ph.D., and others in the January 2008 American Journal of Surgery 195, pp. 89-93.

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