Watchful waiting vs repair for asymptomatic or minimally symptomatic inguinal hernia in men: a systematic review
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REVIEW
Watchful waiting vs repair for asymptomatic or minimally symptomatic inguinal hernia in men: a systematic review Hugin Reistrup1 · Siv Fonnes1 · Jacob Rosenberg1 Received: 15 June 2020 / Accepted: 1 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose One-third of patients presenting with inguinal hernia are asymptomatic and the best treatment for these patients is unclear. The aim of this study was to assess the feasibility of applying a watchful waiting strategy for asymptomatic or minimally symptomatic inguinal hernia in men. Methods PubMed, EMBASE, and Cochrane Library were searched from database inception to May 14, 2020. Included were all types of original data written in English, German, Danish, Swedish, or Norwegian involving ≥ 5 male patients aged ≥ 18 years old with asymptomatic or minimally symptomatic inguinal hernia and undergoing watchful waiting. This review was reported according to the PRISMA guideline. Results A total of nine studies were included; three randomized controlled trials, three prospective cohort studies, and three retrospective cohort studies. Data on a total of 858 unique patients following a watchful waiting strategy were included. Approximately one-third of patients crossed over from watchful waiting to surgery after 3 years increasing to more than two-thirds after 10 years. The most frequent reason for crossover was hernia-related pain (median 79%, range 48–91%). The rate of acute hernia-related operations was low (2–3%), and watchful waiting was not associated with increased mortality or postoperative complications. Levels of pain and discomfort after randomization were similar over time between patients undergoing elective repair or watchful waiting. Conclusion Applying a watchful waiting strategy to men with asymptomatic or minimally symptomatic inguinal hernia was safe, but two-thirds of patients crossed over to surgical repair within 10 years mainly due to pain. Keywords Inguinal hernia · Watchful waiting · Conservative treatment · Asymptomatic · Systematic review · Pain
Introduction Inguinal hernia is a common condition that will affect 27% of all men at some point throughout their lifetime [1]. Traditionally, surgical repair has been recommended for most patients making hernia repair one of the most common surgical procedures performed worldwide [2]. Today, there is consensus that patients with symptomatic inguinal hernia should be offered repair to improve quality of life [3]. Hernia repair has generally been regarded as a safe procedure with few complications, and though this might be true compared with many other surgical procedures, the repair of inguinal * Hugin Reistrup [email protected] 1
Department of Surgery, Herlev Hospital, Center for Perioperative Optimization, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
hernia does indeed have its challenges. Postoperative chronic pain is a common complication affecting up to 15% of patients following hernia repair [4–7]. A few p
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