Is surgical repair of an asymptomatic groin hernia appropriate? A review

Abstract

Groin herniorrhaphy is the most common operation performed by general surgeons. Annually, more than 20million 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. The review was based on an extensive literature search of Pubmed, Medline and the Cochrane Library. The risk of incarceration is approximately 4 per 1,000 patients with a groin hernia per year. Risk factors for incarceration are age above 60years, femoral hernia site and duration of signs less than 3months. Morbidity and mortality rates of emergency groin hernia repair are higher in patients who are older than 49years, have a delay between onset of symptoms and surgery of more than 12h, 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. Watchful waiting for asymptomatic groin hernias is a safe and cost-effective modality in patients who are under 50years old, have an ASA class of 1 or 2, an inguinal hernia, and a duration of signs of more than 3months.