A 70-year-old man with a reducible inguinal hernia is evaluated. He has a Charlson Comorbidity Index score of 4 and refuses surgery. The Dutch Hernia Study and Fitzgibbons trials support which management for asymptomatic or minimally symptomatic inguinal hernia?

• A Watchful waiting carries 10% annual risk of incarceration requiring emergency surgery
• B All inguinal hernias should be repaired electively to prevent strangulation
• C Watchful waiting is safe; emergency surgery risk is less than 0.5% per year ✓
• D Truss use eliminates need for surgical repair in asymptomatic patients

Explanation

The Fitzgibbons trial (US, NEJM 2006) and Dutch Hernia Study demonstrated that watchful waiting for asymptomatic or minimally symptomatic inguinal hernia in men is safe, with an acute hernia episode (incarceration/strangulation requiring emergency surgery) occurring in less than 0.5% per year. About 72-75% of watchful waiting patients crossed over to surgery within 10 years due to symptom development, but in truly asymptomatic patients, observation is an acceptable alternative to immediate repair. Trusses provide symptomatic relief but do not prevent hernia progression. These trials changed practice away from routine repair for all inguinal hernias.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.