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Is surgical repair of an asymptomatic groin hernia appropriate? A review.
Hernia 2011; 15(3):251-9H

Abstract

PURPOSE

Groin herniorrhaphy is the most common operation performed by general surgeons. Annually, more than 20 million groin hernias are repaired worldwide. The general approach towards groin hernias is surgical repair regardless of the presence of symptoms. The rationale to recommend surgery for asymptomatic groin hernias is prevention of visceral strangulation. The goal of this review is to evaluate the appropriateness of surgery in patients with asymptomatic groin hernias.

METHODS

The review was based on an extensive literature search of Pubmed, Medline and the Cochrane Library.

RESULTS

The risk of incarceration is approximately 4 per 1,000 patients with a groin hernia per year. Risk factors for incarceration are age above 60 years, femoral hernia site and duration of signs less than 3 months. Morbidity and mortality rates of emergency groin hernia repair are higher in patients who are older than 49 years, have a delay between onset of symptoms and surgery of more than 12 h, have a femoral hernia, have nonviable bowel and have an ASA-class of 3 or 4. The recurrence rate after tension-free mesh repair in the management of emergency groin hernias is comparable to that of elective repair. There is no difference in pain and quality of life after elective repair compared to watchful waiting. There is no advantage in cost-effectiveness of elective repair compared to watchful waiting.

CONCLUSION

Watchful waiting for asymptomatic groin hernias is a safe and cost-effective modality in patients who are under 50 years old, have an ASA class of 1 or 2, an inguinal hernia, and a duration of signs of more than 3 months.

Authors+Show Affiliations

Slotervaartziekenhuis, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands. baukjevdh@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21298308

Citation

van den Heuvel, B, et al. "Is Surgical Repair of an Asymptomatic Groin Hernia Appropriate? a Review." Hernia : the Journal of Hernias and Abdominal Wall Surgery, vol. 15, no. 3, 2011, pp. 251-9.
van den Heuvel B, Dwars BJ, Klassen DR, et al. Is surgical repair of an asymptomatic groin hernia appropriate? A review. Hernia. 2011;15(3):251-9.
van den Heuvel, B., Dwars, B. J., Klassen, D. R., & Bonjer, H. J. (2011). Is surgical repair of an asymptomatic groin hernia appropriate? A review. Hernia : the Journal of Hernias and Abdominal Wall Surgery, 15(3), pp. 251-9. doi:10.1007/s10029-011-0796-y.
van den Heuvel B, et al. Is Surgical Repair of an Asymptomatic Groin Hernia Appropriate? a Review. Hernia. 2011;15(3):251-9. PubMed PMID: 21298308.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is surgical repair of an asymptomatic groin hernia appropriate? A review. AU - van den Heuvel,B, AU - Dwars,B J, AU - Klassen,D R, AU - Bonjer,H J, Y1 - 2011/02/05/ PY - 2010/08/30/received PY - 2011/01/16/accepted PY - 2011/2/8/entrez PY - 2011/2/8/pubmed PY - 2011/12/14/medline SP - 251 EP - 9 JF - Hernia : the journal of hernias and abdominal wall surgery JO - Hernia VL - 15 IS - 3 N2 - PURPOSE: Groin herniorrhaphy is the most common operation performed by general surgeons. Annually, more than 20 million groin hernias are repaired worldwide. The general approach towards groin hernias is surgical repair regardless of the presence of symptoms. The rationale to recommend surgery for asymptomatic groin hernias is prevention of visceral strangulation. The goal of this review is to evaluate the appropriateness of surgery in patients with asymptomatic groin hernias. METHODS: The review was based on an extensive literature search of Pubmed, Medline and the Cochrane Library. RESULTS: The risk of incarceration is approximately 4 per 1,000 patients with a groin hernia per year. Risk factors for incarceration are age above 60 years, femoral hernia site and duration of signs less than 3 months. Morbidity and mortality rates of emergency groin hernia repair are higher in patients who are older than 49 years, have a delay between onset of symptoms and surgery of more than 12 h, have a femoral hernia, have nonviable bowel and have an ASA-class of 3 or 4. The recurrence rate after tension-free mesh repair in the management of emergency groin hernias is comparable to that of elective repair. There is no difference in pain and quality of life after elective repair compared to watchful waiting. There is no advantage in cost-effectiveness of elective repair compared to watchful waiting. CONCLUSION: Watchful waiting for asymptomatic groin hernias is a safe and cost-effective modality in patients who are under 50 years old, have an ASA class of 1 or 2, an inguinal hernia, and a duration of signs of more than 3 months. SN - 1248-9204 UR - https://www.unboundmedicine.com/medline/citation/21298308/Is_surgical_repair_of_an_asymptomatic_groin_hernia_appropriate_A_review_ L2 - https://dx.doi.org/10.1007/s10029-011-0796-y DB - PRIME DP - Unbound Medicine ER -