Posted by medconsumers on February 1, 2007
Hernia Surgery vs “Wait and See”
Surgeons typically tell their hernia patients, even those without symptoms, that they risk dire complications if they do not have it repaired. But hernia surgery itself, though generally safe and effective, also poses long-term risks of hernia recurrence, pain, and discomfort. An unusual clinical trial, published in the January 18, 2006 issue of the Journal of the American Medical Association, compared immediate surgery with a “wait and see” approach. It showed that the surgical repair of a hernia can be safely delayed or avoided completely.
The 720 men who participated in the trial had either minimal or no symptoms of an inguinal hernia. This type of hernia occurs when part of the intestine or abdominal tissue protrudes through a weak point in the muscles of the groin. The much-feared consequence of avoiding surgery is the possibility of a strangulated hernia. The hernia could become trapped and that might cut off the blood supply to the hernia and cause bowel obstruction and life-threatening conditions like gangrene and peritonitis.
The research team led by Robert J. Fitzgibbons, Jr., MD, Creighton University, Omaha, designed the trial to assess both the harms of delaying surgery, as well as the harms of hernia surgery itself. The 720 study participants were randomly assigned to receive either surgery or watchful waiting. The latter involved check-ups at six-month intervals.
Only one man in the watchful-waiting group had experienced acute hernia incarceration without strangulation (at two years) and another had acute incarceration with bowel obstruction at four years. As for the risks of hernia surgery, three men who had surgical repair experienced a life-threatening complication. Other less-severe postoperative complications like urinary tract infections occurred in 22% of the men.
As with the back surgery trial described on the previous page, the hernia study had many crossovers in both directions. Some study participants (23%) assigned to the watchful-waiting group decided to undergo hernia surgery. And 17% of the men assigned to surgery decided to join the watchful-waiting group.
Dr. Fitzgibbons, Jr., and colleagues concluded that watchful waiting is a safe option for men with minimal or no symptoms of an inguinal hernia. And if they choose to delay surgery until their symptoms interfere with everyday activities, they have no greater risk of operative complications than those who choose to undergo immediate hernia surgery.
Maryann Napoli, Center for Medical Consumers ©