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Clinical Decisionmaking

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Watchful waiting is an option for men with minimally symptomatic inguinal hernias

Watchful waiting seems to be a safe method of treating men who have inguinal hernias with minimal or no symptoms, according to a new study funded in part by the Agency for Healthcare Research and Quality (HS09860). Robert J. Fitzgibbons, Jr., M.D., of Creighton University in Omaha, and colleagues randomly assigned 720 men with inguinal hernias with minimal symptoms from five community and academic health centers into two groups: one managed with watchful waiting and a second group who had a hernia repair. Depending on when they entered the study, patients were followed for at least 2 years or 4.5 years between January 1, 1999 and December 31, 2004.

Of the patients in the watchful waiting group, 23 percent requested and received surgical repair within 2 years, primarily because of an increase in hernia-related pain. Patients assigned to watchful waiting who requested surgical repair most commonly reported increased pain as the reason for the crossover, and nearly half reported that pain interfered with normal activities. In the surgical group, 17 percent of patients ultimately refused the procedure within 2 years and opted for watchful waiting.

After 2 years, low proportions of patients in both the watchful waiting and surgical repair groups had pain sufficient to limit usual activities, and their levels of physical functioning were similar. Overall, the rate of complications was similar among those who were assigned to and received surgical repair (21.7 percent) and those assigned to watchful waiting who crossed over to receive surgical repair (27.9 percent), showing that they suffered no penalty for waiting to have the operation until they had developed symptoms.

More details are in "Watchful waiting vs. repair of inguinal hernia in minimally symptomatic men" by Dr. Fitzgibbons, Anita Giobbie-Hurder, M.S., James O. Gibbs, Ph.D., and others, in the January 18, 2006, Journal of the American Medical Association 295(3), pp. 285-292.

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