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Long-Term Results of a Non-Operative Strategy (Watchful Waiting) For Men With Minimally Symptomatic Inguinal Hernias
Robert J Fitzgibbons, Jr., Bala Ramanan*, Shipra Arya*, Scott A Turner*, Timothy J Dickhudt*
Creighton University, Omaha, NE

OBJECTIVE(S):
With an average follow-up of 3.2 years, a randomized controlled trial comparing Watchful Waiting (WW) with routine repair for male patients with minimally symptomatic inguinal hernias lead investigators to conclude that WW was an acceptable option (JAMA. 2006 Jan 18;295(3):285-92). Here we report the crossover rate to surgery after an additional 6 years of follow-up.
METHODS:
254 men who had been assigned to WW consented to longer-term follow-up. These patients were contacted yearly by mail questionnaire. Non-responders were contacted by phone or email for additional data collection.
RESULTS:
Patients have now been followed for a mean of 8.75 years. The cumulative crossover rate over the next six years (2005-2010) was 40% (2005), 43.7% (2006), 44.5% (2007), 49.4% (2008), 50.2% (2009) and 53.9% (2010) respectively. The most common reason for crossover was pain (51.2%). On multivariate analyses, crossover to surgery was associated with age more than 65 years (odds ratio [OR] 3.65; 95% confidence interval [CI]-1.33-10) and postgraduate education versus college education (OR 3.05; 95% CI-1.09-8.55). Kaplan Meier analyses (Figure 1) predicts that 60% of patients will crossover to surgery by 10 years from randomization.
CONCLUSIONS:
Although WW is a reasonable strategy for a minimally symptomatic inguinal hernia, crossover to operation is highly likely if patients live long enough.


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