Whether or not you decide to undergo hernia repair surgery without symptoms from the hernia is a decision between you and your surgeon. Recommendations for treatment of an asymptomatic hernia have changed several times over the last 15 years. Years ago, everyone was encouraged to have hernia surgery as soon as the diagnosis was made. The rationale was that there is a chance that intestine can get stuck in the hernia, leading to strangulation, which is a medical emergency. Since emergency surgery for a strangulated hernia can be complicated, potentially leading to major complications or death, surgeons warned patients about the risks of emergency surgery and suggested hernia repair right away.
Watchful waiting for inguinal hernia
In 2006, a landmark study showed that the chance that a minimally symptomatic hernia will lead to strangulation was less than 1% per patient per year. Because the risk of emergency surgery is so low, some surgeons would start to counsel patients that it is safe to monitor the hernia until it becomes symptomatic. This study identified that the majority of patients do develop more significant symptoms over several years, and actually ask to have hernia surgery before requiring any sort of emergency surgery.
Progression to symptoms in most inguinal hernia patients
More recent studies show that about 80% of patients with inguinal hernia develop enough symptoms over 10 years that they end up needing surgery. After this study, most surgeons recommend that patients have their hernias fixed while they are young, in order to reduce complications of surgery related to diseases (heart disease, diabetes, etc.) more common as we age.
Shared decision making in hernia surgery
In our practice, we like to make recommendations based on each individual’s unique situation. For patients who are healthy and have completely asymptomatic hernias, we recommend watchful waiting, as the risk of waiting is less than the risk of potential complications from elective hernia surgery. For patients with minimally symptomatic hernias, we come up with a plan together as to whether or not surgery is better performed now or at a later time. For patients with symptomatic or larger hernias we almost always recommend the fast recovery repair.
About Dr. Reinhorn & Dr. Fullington
Dr. Michael Reinhorn is a specialist in inguinal hernia and umbilical hernia. Dr. Reinhorn started his practice as a full service general surgeon in 2001. In 2012 Dr. Reinhorn started to focus on the care of hernia and pilonidal patients. In 2020, Dr. Nora Fullington was recruited from her work as a general surgeon performing hundreds of laparoscopic hernia repairs to Boston Hernia. Together with their physician assistant team, they provide a focused practice designed to provide a superior clinical experience. The team performs approximately 700 hernia surgeries every year and offers a tailored approach for each patient from anesthesia type to consideration of mesh and no mesh repairs, laparoscopic and open surgery. We have published outcomes and continue to participate in hernia and surgery societies. Our research led to a reduction in opioid prescribing after hernia surgery. Currently, Dr. Reinhorn serves as the chair of the Opioid Reduction Task Force of the Americas Hernia Society Quality Collaborative.