Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias.
نویسندگان
چکیده
OBJECTIVE To assess the long-term crossover (CO) rate in men undergoing watchful waiting (WW) as a primary treatment strategy for their asymptomatic or minimally symptomatic inguinal hernias. BACKGROUND With an average follow-up of 3.2 years, a randomized controlled trial comparing WW with routine repair for male patients with minimally symptomatic inguinal hernias led investigators to conclude that WW was an acceptable option [JAMA. 2006;295(3):285-292]. We now analyze patients in the WW group after an additional 7 years of follow-up. METHODS At the conclusion of the original study, 254 men who had been assigned to WW consented to longer-term follow-up. These patients were contacted yearly by mail questionnaire. Nonresponders were contacted by phone or e-mail for additional data collection. RESULTS Eighty-one of the 254 men (31.9%) crossed over to surgical repair before the end of the original study, December 31, 2004, with a median follow-up of 3.2 (range: 2-4.5) years. The patients have now been followed for an additional 7 years with a maximum follow-up of 11.5 years. The estimated cumulative CO rates using Kaplan-Meier analysis was 68%. Men older than 65 years crossed over at a considerably higher rate than younger men (79% vs 62%). The most common reason for CO was pain (54.1%). A total of 3 patients have required an emergency operation, but there has been no mortality. CONCLUSIONS Men who present to their physicians because of an inguinal hernia even when minimally symptomatic should be counseled that although WW is a reasonable and safe strategy, symptoms will likely progress and an operation will be needed eventually.
منابع مشابه
Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial.
CONTEXT Many men with inguinal hernia have minimal symptoms. Whether deferring surgical repair is a safe and acceptable option has not been assessed. OBJECTIVE To compare pain and the physical component score (PCS) of the Short Form-36 Version 2 survey at 2 years in men with minimally symptomatic inguinal hernias treated with watchful waiting or surgical repair. DESIGN, SETTING, AND PARTICI...
متن کاملCanadian Association of General Surgeons and American College of Surgeons evidence-based reviews in surgery. 26. Watchful waiting versus repair of inguinal hernia in minimally symptomatic men.
Objective: To compare pain and physical function in men with minimally symptomatic inguinal hernia with watchful waiting or surgical repair. Design: Randomized controlled trial. Setting: Five community and academic centres in Canada and the United States. Patients: A total of 724 men were randomly assigned to a watchful waiting group (n = 366) versus a standard Lichtenstein open tension-free re...
متن کاملInguinal hernias: should we repair?
This review examines available data concerning the natural history of treated and untreated inguinal hernias. The incidence of complications with either treatment strategy is discussed using historical information from a time before herniorrhaphy became routine and contemporary data from two recently completed randomized controlled trials comparing routine repair using a tension-free technique ...
متن کاملDevelopment of a clinical trial to determine whether watchful waiting is an acceptable alternative to surgical repair for patients with oligosymptomatic incisional hernia: study protocol for a randomized controlled trial
BACKGROUND Incisional hernia is a frequent complication in abdominal surgery. This article describes the development of a prospective randomized clinical trial designed to determine whether watchful waiting is an acceptable alternative to surgical repair for patients with oligosymptomatic incisional hernia. METHODS/DESIGN This clinical multicenter trial has been designed to compare watchful w...
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ورودعنوان ژورنال:
- Annals of surgery
دوره 258 3 شماره
صفحات -
تاریخ انتشار 2013