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Delaying surgery for hernia repair a safe option

Men who delay surgical repair of a hernia until the hernia becomes uncomfortable fare as well those who undergo immediate surgery, according to a study at five North American medical centers.

In the study, published in the Jan. 18 issue of JAMA, a journal of the American Medical Association, 720 men with inguinal hernia (a small part of the large or small intestine protruding into the groin) were randomly assigned to either "watchful waiting" or standard hernia repair surgery and followed up for two to 4.5 years.

In an earlier study, the researchers had compared non-invasive laparoscopic hernia operations with open procedures. "But there are a lot of men walking around with hernias who say, 'If it's not bothering me, I won't bother it,'" said Dr. Olga Jonasson, professor of surgery at the University of Illinois at Chicago, who initiated the study. "We wanted to know if it was safe to delay surgery altogether."

Of the 364 men assigned to watchful waiting, 23 percent later chose to have surgery, usually because of increased pain. Seventeen percent of the 356 men assigned to surgery chose instead to cross over into watchful waiting. Waiting did not increase the rate of complications from surgery in those patients who eventually had it, and the rate of complications from hernias left unrepaired was even lower.

After two years, the same proportion of men in each group reported developing pain great enough to interfere with everyday activities, but both groups overall reported less pain at the end of the two years. Patients who received surgical repair reported significantly greater improvement in their ability to perform a range of everyday activities.

The authors conclude that a strategy of watchful waiting is "a safe and acceptable option" for men whose hernias are not causing discomfort that interferes with their day-to-day activities. Hernia complications occur only rarely, and pati
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Contact: Jeanne Galatzer-Levy
jgala@uic.edu
312-996-1583
University of Illinois at Chicago
17-Jan-2006


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