50+ Lifestyles

Iguinal Hernias – Don’t Wait

By Joseph L. Lohmuller, MD, MS, FACS
Davenport Surgical Group, PC

Recently, I was in the outpatient surgery center preparing a patient for a hernia repair. As I was reviewing surgery with her and her husband, the patient began to look accusingly at him. She remarked that once her hernia was fixed, that her husband should get his inguinal (groin) hernia fixed as well. He was not so keen on this idea, reporting that his family doctor had told him that he need not worry about it.

In the JAMA in 2006, a very well-done study was published that looked at a prospective randomized trial of “watchful waiting” versus repair of inguinal hernias. This was in minimally symptomatic or asymptomatic men who had brought the hernia to the doctor’s attention or came to the doctor to ask whether or not the hernia was an issue. The conclusion of the trial was that “watchful waiting” is a reasonable option for men whose hernia is minimally symptomatic. The hernia could be repaired if symptoms developed.

Fast forward to 2013. A long-term follow-up study looked at the 10-year follow-up data and results from participants in the initial trial. There were over 700 men enrolled, half of these patients were put in the watchful waiting group and approximately 32 percent of those ended up with surgical repair within five years because of symptoms. But, within ten years, request for repair based on symptoms such as pain reached 68 percent in all patients. The request for repair in patients over age 65 was higher at 79 percent, leaving the authors to conclude that the initial recommendation to proceed with “watchful waiting” was not optimal, and recommending repair at a convenient time is the better choice.

One issue of watching patients with hernias who are older is that their health will likely never improve significantly as they age. Surgical risks are generally increased over time with results of aging that can lead to deterioration of health, making surgery a more difficult decision in some.
Depending on the age and physical activity of the patient, the standard recommendation is to repair inguinal hernias at a convenient time.

Joseph L. Lohmuller MD, MS, FACS is a physician at Davenport Surgical Group PC. and an Adjunct Clinical Professor of Surgery at the University of Iowa Carver College of Medicine, Iowa City, Iowa For more information call
(563) 823-9300.