Men who have a hernia that does not cause pain or discomfort may nor need I V I surgery, a new study has found.
Hernias occur when a portion of an organ (the intestine, for example) protrudes through an abnormal opening in the muscle wall, often as the result of a muscle tear injury. Sometimes the organ can become incarcerated, or caught, in this opening, and strangulated if its blood supply is cut off.
The Study
Researchers compared the pain, physical function and other outcomes in 720 men who had asymptomatic or minimally symptomatic inguinal hernias, which are the most common type and occur near the groin.
Some of the participants were randomly selected to have their hernia repaired, while others did not have surgery.
After two years, the research team measured pain levels for both groups of men and found a similar number of patients in each group had pain that was significant enough to interfere with daily activities.
Implications
The finding "changes the traditional teaching that's been taught for hundreds of years," says lead author Dr. Robert J. Fitzgibbons, Jr., a professor of surgery at Creighton University in Omaha. "Patients should understand that they don't have to have their hernias fixed, if they can live with it.
"In the past, doctors have told men that they have to fix hernias because of the danger of incarceration leading to gangrene," says Fitzgibbons. "Those data were based on historical times when medical care wasn't immediately available," he adds.
"For men who have little or no symptoms from a hernia, it is safe to defer having an operation until they do have symptoms," says study coauthor Dr. Olga Jonasson, a professor of surgery at the University of Illinois at Chicago.
Complications From Surgery
Jonasson notes that hernia surgery can cause complications. "The main complication is that after having a hernia repaired, many men will have chronic groin pain that will last for years," she says.
"There are men who have had hernias for 40 years, and it doesn't bother them and they don't bother it," Jonasson says.
Dr. David R. Flum, an associate professor of surgery at the University of Washington in Seattle, agrees that surgery is not always necessary. "There are tons of people who have hernias who don't even know they have them," he says.
The major risk of not having hernia surgery is strangulation, and according to Flum, this risk is very small.
"If you operate on people preventively, before they have symptoms, they don't do any better or any worse than the group of people who decide they are going to watch and wait, and if it becomes symptomatic fix it," he says.
"I have been practicing this way for years," agrees Dr. Robert Bell, an assistant professor of surgery at Yale University School of Medicine. "I tell patients, 'If it doesn't bother you, you don't need to get it fixed. If it ever does bother you, you know where to find me. If it even bothers you psychologically, we will go a head and fix it."
