The current status of watchful waiting for inguinal hernia management: a review of clinical evidence

Abstract

Inguinal hernias are a very common problem and the most common reason for primary care physicians to refer patients for surgery. The diagnosis is usually made from history and physical examination and men are significantly more likely to be affected than women. Most patients will present with a painful bulge in the groin, though up to a third of patients will be asymptomatic at the time of diagnosis. Previously, it had been recommended that all hernias be repaired surgically at the time of diagnosis to prevent the development of a hernia accident (bowel obstruction or strangulation) that would require emergent surgery, which is associated with much higher morbidity and mortality than an elective repair. However, several clinical trials have reported that risks of a hernia accident are sufficiently low so that a “watchful waiting” (WW) approach for male patients who are asymptomatic or minimally symptomatic is a safe management strategy. WW spares patients any risk of operative complications related to their herniorrhaphy, perhaps the most significant of which is post-herniorrhaphy groin pain that has only recently been appreciated as a significant issue. Although WW has now been proven to be safe in asymptomatic males with an inguinal hernia, long-term results of randomized controlled trials have shown that most patients initially managed with WW will eventually elect to have the hernia surgically repaired primarily due to increased pain. The purpose of this article is to review the current evidence on watchful waiting for the management of inguinal hernias.

Keywords

Inguinal hernia / watchful waiting / groin hernia / herniorrhaphy

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