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Hernias: 'Watchful Waiting' Proposed

Researchers Say Men Without Symptoms May Not Need Surgery
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Risks vs. Benefits continued...

After two years of follow-up, the incidence of pain severe enough to interfere with activities was similar in both patient groups.

Serious hernia-related complications in the watchful-waiting group were very rare, occurring at a rate of about one-fifth of a percent per year, Fitzgibbons says.

At two years, 23% of the patients assigned to watchful waiting had opted for surgical repair of their hernia, most often due to increasing hernia-related pain.

But surgical complication rates were similar in patients operated on early and those treated with surgery later after hernia symptoms increased.

"There did not appear to be a penalty for delaying surgery," says Fitzgibbons, who is chief of the division of general surgery at Creighton University in Omaha, Neb.

What About Women?

The findings from the all-male study cannot be extrapolated to women, who have a more complicated clinical picture when it comes to hernias, Fitzgibbons says. Women are far more likely than men to develop a different type of groin protrusion known as a femoral hernia. These hernias can be hard to distinguish from inguinal hernias and are more likely to result in serious complications.

For this reason, a watchful-waiting approach is probably not appropriate for women in most cases, he says.

Gastrointestinal surgeon David R. Flum, MD, MPH, tells WebMD that the new study confirms what many clinicians have long suspected -- that watchful waiting is an appropriate strategy for the management of hernias that have no symptoms other than the bulging.

He says it will definitely change the way doctors counsel their patients. But it remains to be seen, he adds, if patients will embrace the watchful-waiting approach.

Flum wrote an editorial accompanying the study. He is an associate professor of medicine at the University of Washington, Seattle.

"Many patients perceive a lump in their groin as being broken, even when it doesn't cause them pain," he says. "There will always be folks who want to get rid of the bulge or who don't want to wait around for something to happen, just like there are people who want to avoid surgery unless they absolutely need it."

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