Many men with an inguinal hernia (the most common type of hernia, occurring near the groin) are asymptomatic or minimally symptomatic, according to background information in the article. These men and their physicians sometimes delay hernia repair until emergence of pain or discomfort. Surgical repair, while generally safe and effective, carries long-term risks of hernia recurrence, pain, and discomfort. The natural history of an untreated inguinal hernia is not known. Whether delaying surgery and "watchful waiting" is a good option has not been critically tested.
Robert J. Fitzgibbons, Jr., M.D., of Creighton University, Omaha, Neb., and colleagues compared pain, physical function, and other outcomes in men with asymptomatic or minimally symptomatic inguinal hernias who were randomly assigned to a strategy of watchful waiting or surgical repair. The randomized trial, conducted January 1, 1999, through December 31, 2004, included 720 men (364 watchful waiting, 356 surgical repair) who were followed up for 2 to 4.5 years. Watchful-waiting patients were followed up at 6 months and annually and watched for hernia symptoms; surgical repair patients received standard open tension-free hernia repair and were followed up at 3 and 6 months and annually.
At 2 years, intention-to-treat analyses showed that pain interfering with activities developed in similar proportions in both groups (5.1 percent for watchful waiting vs. 2.2 percent for surgical repair; difference 2.86 percent). Average 2-year measurements of pain and discomfort as determined with the physical component score (PCS) were not significantly different from baseline: watchful-waiting patients improved by 0.29 points (of 100) and surgi
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