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A clinician's guide to patient selection for watchful waiting management of inguinal hernia.
Ann Surg 2011; 253(3):605-10AnnS

Abstract

OBJECTIVE

The goal of this study was to assist surgeons in managing patients with minimally symptomatic inguinal hernia by identifying characteristics that predict crossover to surgery or worsening of hernia symptoms.

BACKGROUND

Randomized trials have suggested that watchful waiting management of minimally symptomatic inguinal hernia is an acceptable alternative to surgical repair. However, these trials found that roughly a quarter of patients would elect for repair in the first 2 years, suggesting that not all patients are good candidates for watchful waiting.

METHODS

The 336 patients randomized to watchful waiting in the American College of Surgeons Watchful Waiting Hernia Trial constituted the study population. Preoperative patient characteristics were used to predict 2 outcomes, either crossover to surgery or the development of hernia pain limiting activities and/or crossover to surgery. Patients in our study were part of a previously registered randomized trial: NCT00263250.

RESULTS

At 2 years, 72 patients crossed over to surgery, with pain with strenuous activities [odds ratio (OR), 1.3 per 10-mm visual analog scale pain scale], chronic constipation (OR, 4.9), prostatism (OR, 2.9), being married (OR, 2.3), and good health [OR, 3.0 American Society of Anesthesiologists Class (ASA) 1 vs 2], predicting crossover. An additional 28 patients developed pain, limiting their activities, with pain during strenuous activities (OR, 1.3 per 10-mm visual analog scale) and chronic constipation (OR, 4.5), predicting the combined outcome of pain limiting activities and/or crossover to surgery. Higher levels of activity reduced the risk (OR, 0.95) of this combined outcome.

CONCLUSIONS

Readily identifiable patient characteristics can predict those patients with minimally symptomatic inguinal hernia who are likely to "fail" watchful waiting hernia management. Consideration of these factors will allow surgeons to optimally tailor hernia management.

Authors+Show Affiliations

Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA. george.sarosi@surgery.ufl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

21239979

Citation

Sarosi, George A., et al. "A Clinician's Guide to Patient Selection for Watchful Waiting Management of Inguinal Hernia." Annals of Surgery, vol. 253, no. 3, 2011, pp. 605-10.
Sarosi GA, Wei Y, Gibbs JO, et al. A clinician's guide to patient selection for watchful waiting management of inguinal hernia. Ann Surg. 2011;253(3):605-10.
Sarosi, G. A., Wei, Y., Gibbs, J. O., Reda, D. J., McCarthy, M., Fitzgibbons, R. J., & Barkun, J. S. (2011). A clinician's guide to patient selection for watchful waiting management of inguinal hernia. Annals of Surgery, 253(3), pp. 605-10. doi:10.1097/SLA.0b013e31820b04e9.
Sarosi GA, et al. A Clinician's Guide to Patient Selection for Watchful Waiting Management of Inguinal Hernia. Ann Surg. 2011;253(3):605-10. PubMed PMID: 21239979.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A clinician's guide to patient selection for watchful waiting management of inguinal hernia. AU - Sarosi,George A, AU - Wei,Yongliang, AU - Gibbs,James O, AU - Reda,Domenic J, AU - McCarthy,Martin, AU - Fitzgibbons,Robert J, AU - Barkun,Jeffrey S T, PY - 2011/1/18/entrez PY - 2011/1/18/pubmed PY - 2011/4/5/medline SP - 605 EP - 10 JF - Annals of surgery JO - Ann. Surg. VL - 253 IS - 3 N2 - OBJECTIVE: The goal of this study was to assist surgeons in managing patients with minimally symptomatic inguinal hernia by identifying characteristics that predict crossover to surgery or worsening of hernia symptoms. BACKGROUND: Randomized trials have suggested that watchful waiting management of minimally symptomatic inguinal hernia is an acceptable alternative to surgical repair. However, these trials found that roughly a quarter of patients would elect for repair in the first 2 years, suggesting that not all patients are good candidates for watchful waiting. METHODS: The 336 patients randomized to watchful waiting in the American College of Surgeons Watchful Waiting Hernia Trial constituted the study population. Preoperative patient characteristics were used to predict 2 outcomes, either crossover to surgery or the development of hernia pain limiting activities and/or crossover to surgery. Patients in our study were part of a previously registered randomized trial: NCT00263250. RESULTS: At 2 years, 72 patients crossed over to surgery, with pain with strenuous activities [odds ratio (OR), 1.3 per 10-mm visual analog scale pain scale], chronic constipation (OR, 4.9), prostatism (OR, 2.9), being married (OR, 2.3), and good health [OR, 3.0 American Society of Anesthesiologists Class (ASA) 1 vs 2], predicting crossover. An additional 28 patients developed pain, limiting their activities, with pain during strenuous activities (OR, 1.3 per 10-mm visual analog scale) and chronic constipation (OR, 4.5), predicting the combined outcome of pain limiting activities and/or crossover to surgery. Higher levels of activity reduced the risk (OR, 0.95) of this combined outcome. CONCLUSIONS: Readily identifiable patient characteristics can predict those patients with minimally symptomatic inguinal hernia who are likely to "fail" watchful waiting hernia management. Consideration of these factors will allow surgeons to optimally tailor hernia management. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/21239979/A_clinician's_guide_to_patient_selection_for_watchful_waiting_management_of_inguinal_hernia_ L2 - http://Insights.ovid.com/pubmed?pmid=21239979 DB - PRIME DP - Unbound Medicine ER -