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Watchful Waiting or Hernia Repair?

Hernias can present as large or small and symptomatic or asymptomatic. There is no definitive understanding why some hernias are symptomatic while others are generally painless. Further, there is no correlation between the size of a hernia and whether it causes pain. This uncertainty brings up a common question from patients wanting to know if they need to repair a hernia or if they can wait – known as watchful waiting.

Conventional wisdom dictates that almost all hernias should be repaired. This is because a hernia does not get better over time and the hernia, which is a defect in the fascia of the abdominal wall, cannot heal itself. Only surgery can repair a hernia. Further, an elective or scheduled hernia repair is associated with fewer risks and complications than emergency hernia repairs. Emergent surgery is almost always more complex and more serious in nature.

Rarely, a hernia can become strangulated or incarcerated which means that the loop of intestine pushing through the abdominal fascia gets stuck, causing a reduction or elimination of blood flow to the organ. This is an emergency that may also result in the need to remove the part of intestine that has been damaged by restriction of blood flow. Potential complications are far greater in cases such as these.

However, the strategy of watchful waiting can be employed when:

  1. Patients who do not present with any symptoms (asymptomatic) may not need to have it repaired, if they do not wish to do so. Of course, they run the slight risk of strangulation, detailed above. Further, the hernia cannot repair itself and will likely enlarge and become more symptomatic as times goes on. However, in most patients, hernia repair surgery is employed to address a quality of life issue. Therefore, if the patient is experiencing no symptoms from their hernia, they may elect to wait and have their hernia repaired when symptoms develop in the future.
  2. Patients with larger hernias that do not affect their daily lives may also consider waiting for surgery. Larger hernias have a lower chance of strangulation and in turn reduce the risk of an emergency procedure in the future.

Ultimately, however, minimally invasive hernia surgery requires very little downtime and is performed in an outpatient setting. Typically, patients require a weekend to recover from surgery and may be back at work by the following week. Most activities can be performed within a week and more strenuous activities within 3 weeks – with doctor approval.

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