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Surgery Not Always the Answer for Hernias

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TUESDAY, Jan. 17 (HealthDay News) -- Men who have a hernia without pain or discomfort may have no need for surgery, a new study concludes.

The finding "changes the traditional teaching that's been for hundreds of years," said lead author Dr. Robert J. Fitzgibbons, Jr., a professor of surgery at Creighton University in Omaha, Neb. "Patients should understand that they don't have to have their hernias fixed, if they can live with it."

The study focused on men with inguinal hernia -- the most common type of hernia, occurring near the groin. It found that men with minimal or no symptoms who did not have their hernia repaired had similar levels of pain and discomfort two years later as those who underwent surgical repair.

The report appears in the Jan. 18 issue of the Journal of the American Medical Association.

Hernias occur when a portion of an organ (for example, the intestine) protrudes through an abnormal opening in the muscle wall, often as the result of a muscle tear injury. Sometimes the organ can become caught, or "incarcerated," in this opening, causing its blood supply to be cut off, or "strangulated."

"In the past, doctors have told men that they have to fix their hernias because of the danger of incarceration leading to gangrene," said Fitzgibbons. "Those data were based on historical times when medical care wasn't immediately available," he added.

In their study, the researchers compared pain, physical function and other outcomes in men with asymptomatic or minimally symptomatic inguinal hernias. The 720 men in the trial were randomly selected to have their hernia repaired or not.

After two years, Fitzgibbon's team found that the number of patients with levels of pain high enough to interfere with daily activities was similar for both groups.

"Men who have little or no symptoms from a hernia, it is safe for them to defer having an operation until they do have symptoms," said co-author Dr. Olga Jonasson, a professor of surgery at the University of Illinois, Chicago.

Joanasson noted that having a hernia operated on can cause complications from the surgery itself. "The main complication is that many men after having a hernia repaired will have chronic groin pain that will last for years," she said.

"There are men who have had hernias for 40 years, and it doesn't bother them and they don't bother it," Joansson said. "If it is not broken, don't fix it," she said.

One expert agreed with the findings.

"There are tons of people who have hernias who don't even know they have them," said Dr. David R. Flum, an associate professor of surgery at the University of Washington, and author of an accompanying editorial in the journal. "The question is, 'what's the risk of living with the hernia?'"

The risk of a hernia becoming a strangulating hernia that has to be fixed is very small, Flum added. "If you operate on people preventively, before they have symptoms, they don't do any better or any worse than the group of people who decide they are going to watch and wait, and if it becomes symptomatic fix it," he said.

"It makes sense with hernias, if it's not broken, there is really no reason to fix it," Flum said.

Another expert agrees that the best treatment for an asymptomatic hernia is no treatment.

"I have been practicing this way for years," said Dr. Robert Bell, an assistant professor of surgery at Yale University School of Medicine. "I tell patients, if it doesn't bother you, you don't need to get it fixed. If it ever does bother you, you know where to find me. If it even bothers you psychologically, we will go ahead and fix it."

More information

For more on hernias, head to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Olga Jonasson, M.D., professor, surgery, University of Illinois, Chicago; Robert J. Fitzgibbons, Jr., M.D., professor, surgery, Creighton University, Omaha, Neb.; David R. Flum, M.D., M.P.H., associate professor, surgery, University of Washington, Seattle; Robert Bell, M.D., assistant professor, surgery, Yale University School of Medicine, New Haven, Conn.; Jan. 18, 2006, Journal of the American Medical Association
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