Asymptomatic inguinal hernia: does it need surgical repair? A systematic review and meta-analysis.

Autor: Cirocchi R; Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy., Burini G; Deparment of General and Emergency Surgery, General and Emergency Surgical Clinic of Ancona, Ancona, Italy., Avenia S; Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy., Tebala G; Surgical Emergency Unit, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK., Palumbo P; Department of Surgical Sciences, 'Sapienza' University of Rome, Azienda Policlinico Umberto I Viale del Policlinico, Rome, Italy., Cianci MC; Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy., Morabito A; Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy., Bruzzone P; Department of General and Specialist Surgery 'Paride Stefanini', Sapienza University, Azienda Policlinico Umberto I Viale del Policlinico, Rome, Italy.
Jazyk: angličtina
Zdroj: ANZ journal of surgery [ANZ J Surg] 2022 Oct; Vol. 92 (10), pp. 2433-2441. Date of Electronic Publication: 2022 Mar 26.
DOI: 10.1111/ans.17594
Abstrakt: Background: The aim of this review is to compare the outcomes of surgical repair versus watchful waiting in asymptomatic or minimally symptomatic inguinal hernias.
Methods: Preferred reporting items for systematic reviews and meta-analyses guidelines were employed. We analysed primary outcomes: pain, quality of life, pain during daily activities and visual analogue scale (VAS that measures pain at rest and on movement) and secondary outcomes: postoperative complications and recurrence.
Results: Pain and quality of life were not comparable due to differences in the parameters used in different articles. Pain interfering with normal daily activity was evaluated in one study and appears more favourable in the post-repair group respect to the watchful waiting (WW) group (5.1% versus 2.2%). VAS, measured in one study, at 6 months was more favourable in the surgery group (37% versus 44%). After 12 months the outcome was better in the control group than in the repair group (28% versus 30%). Conversion rate of the patient cohorts from watchful waiting to elective surgery was between 35.03% and 57.8%. The meta-analysis did not find significant statistical differences in the two groups examined for postoperative complications [RR = 0.95, 95% CI (0.50, 1.80), P = 0.88], as for hernia recurrence [RR = 1.01, 95% CI (0.50, 2.02), P = 0.98].
Conclusion: WW seems to be an acceptable option for the patient with asymptomatic or minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms appear is safe. Acute hernia incarcerations are not particularly frequent. The incidence of chronic pain after the repair is high. Physicians must select patients carefully and explain to them the risks and benefits of surgery.
(© 2022 Royal Australasian College of Surgeons.)
Databáze: MEDLINE
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