Men with hernias but little or no pain can safely go without surgery unless things really start to hurt, a study found.
“Not every hernia needs to be fixed,” said Dr. Olga Jonasson of the University of Illinois at Chicago, co-author of the study in Wednesday’s Journal of the American Medical Association.
U.S. surgeons fix more than 600,000 hernias a year, making it one of the most common procedures. The study offers guidance to doctors on whether it is OK to leave a pain-free hernia untreated.
In an accompanying editorial, Dr. David Flum of the University of Washington’s surgery department said hernia surgery for patients without pain may soon disappear, just as preventive tonsillectomies have done.
“We’ve really moved far away from preventive surgery, and this is another example of that,” said Flum, who was not involved in the study.
Groin hernias look like a lump under the skin and are caused when part of the intestine bulges through a weak part of the muscle wall of the abdomen. Men get them more often than women. Muscle strain from heavy lifting, obesity and persistent coughing can lead to hernias.
They can cause painful bowel obstructions and sometimes can cut off blood to part of the bowel, requiring emergency surgery. Doctors repair them by opening the abdomen, pushing the intestine back where it belongs and sometimes reinforcing the opening with mesh before stitching the muscle wall and skin closed.
Researchers followed 720 men, most of them middle-aged, with groin hernias for about four years. Half were randomly assigned to get their hernias fixed. The other half were told to do nothing except see their doctors periodically and if the hernias got bad.
After two years, the groups had similar levels of pain. Only two men in the “watchful waiting” group developed severe problems with their hernias after four years.
About 30 percent of the men in the “watchful waiting” group decided to have surgery during the four years because they developed symptoms. And about 17 percent of the men assigned to surgery did not go through with it, possibly for other health reasons.
About 20 percent of the men who had surgery had surgical complications, including three men whose complications were life-threatening.
“The operation itself is not necessarily a free ride,” Jonasson said.