Asymptomatic inguinal hernia: does it need surgical repair? A systematic review and meta-analysis

Introduction. Aim of this review is to compare the outcomes of surgical repair versus watchful waiting in asymptomatic or minimally symptomatic inguinal hernias. Methods. PRISMA guidelines were employed. We analyzed primary outcomes: pain, quality of life, pain during daily activities and VAS (Visual Analogue Scale which measures pain at rest and on movement) and secondary outcomes: postoperative complications and recurrence. Results. Pain and quality of life were not comparable due to differences in the parameters used in different articles. Pain interfering with normal daily activity was evaluated in one study and appears more favorable in the post repair group respect to WW group (5.1% versus 2.2%). VAS, measured in one study, at 6 months was more favorable in the surgery group (37% vs. 44%). After 12 months the outcome was better in the control group than in the repair group (28% vs. 30%). Conversion rate of the patient cohorts from watchful waiting to elective surgery was between 35.03% and 57.8%. The meta-analysis didn’t find significant statistical differences in the two groups examined for postoperative complications [RR = 0.95, 95% CI (0.50, 1.80), p = 0.88], as for hernia recurrence [RR=1.01, 95% CI (0.50, 2.02), p=0.98]. Conclusion. WW seems to be an acceptable option for patient with asymptomatic or minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms appear is safe. Acute hernia incarcerations are not particularly frequent [1]. Incidence of chronic pain after repair is high. Physicians must select patients carefully and explain to them the risks and benefits of surgery.