From the Guidelines
Watchful waiting is appropriate for hernia when the hernia is small, causes minimal or no symptoms, and doesn't significantly impact daily activities, as long as the patient is closely monitored for signs of complications such as strangulation or incarceration 1.
Key Considerations for Watchful Waiting
- The hernia should be small and asymptomatic or minimally symptomatic
- The patient should be an adult, especially older patients or those with medical conditions that increase surgical risks
- Regular follow-up with a healthcare provider every 6-12 months is necessary to assess any changes in the hernia
- Patients should monitor their hernia for changes such as increasing size, pain, or difficulty reducing the hernia
- If the hernia becomes painful, irreducible, or shows signs of strangulation, immediate medical attention is necessary
Lifestyle Modifications for Watchful Waiting
- Avoid heavy lifting (typically limiting to 15-20 pounds)
- Maintain a healthy weight
- Avoid constipation
- Stop smoking to reduce strain on the abdominal wall
Rationale Behind Watchful Waiting
- Not all hernias progress to complications
- The risks of surgery may outweigh the benefits in certain patients
- Watchful waiting allows for close monitoring and prompt intervention if complications arise It is essential to note that the decision to pursue watchful waiting should be made on a case-by-case basis, taking into account the individual patient's unique circumstances and medical history. Patients should be thoroughly informed of the potential risks and benefits of watchful waiting and should be closely monitored for any changes in their condition.
From the Research
Watchful Waiting for Hernia
Watchful waiting is a management strategy for asymptomatic or minimally symptomatic inguinal hernias. The following points highlight when watchful waiting is appropriate for hernia:
- Watchful waiting is a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias 2.
- Patients with symptomatic hernias or nonpregnant women are not recommended for watchful waiting 2.
- Approximately one-third of patients crossed over from watchful waiting to surgery after 3 years, increasing to more than two-thirds after 10 years 3.
- The most frequent reason for crossover was hernia-related pain (median 79%, range 48-91%) 3.
Patient Characteristics for Watchful Waiting
Certain patient characteristics can predict those who are likely to "fail" watchful waiting hernia management:
- Pain with strenuous activities, chronic constipation, prostatism, being married, and good health predict crossover to surgery 4.
- Higher levels of activity reduce the risk of crossover to surgery or development of hernia pain limiting activities 4.
Safety of Watchful Waiting
Watchful waiting is safe for men with minimally symptomatic inguinal hernias:
- Acute hernia incarcerations occur rarely, with a frequency of 1.8/1000 patient-years 5.
- Watchful waiting is not associated with increased mortality or postoperative complications 3.
- Levels of pain and discomfort after randomization are similar over time between patients undergoing elective repair or watchful waiting 3.