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McBee et al. Mini-invasive Surg 2021;5:18 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.08

Review Open Access

The current status of watchful waiting for inguinal

hernia management: a review of clinical evidence

1
Patrick J. McBee , Robert J. Fitzgibbons, Jr 2
1
Creighton University School of Medicine, Omaha, NE 68178, USA.
2
Department of Surgery, Creighton University Medical Center, Omaha, NE 68131, USA.
Correspondence to: Dr. Robert J. Fitzgibbons, Jr, Department of Surgery, Creighton University Medical Center, Creighton
University Education Building 7710 Mercy Road, Suite 501 Omaha, Nebraska 68124, USA. E-mail: fitzjr@creighton.edu

How to cite this article: McBee PJ, Fitzgibbons, Jr RJ. The current status of watchful waiting for inguinal hernia management: a
review of clinical evidence. Mini-invasive Surg 2021;5:18. https://dx.doi.org/10.20517/2574-1225.2021.08

Received: 22 Jan 2021 First Decision: 15 Feb 2021 Revised: 21 Feb 2021 Accepted: 25 Feb 2021 Available online: 17 Apr 2021

Academic Editor: William W. Hope Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Inguinal hernias are a very common problem and the most common reason for primary care physicians to refer
patients for surgery. The diagnosis is usually made from history and physical examination and men are significantly
more likely to be affected than women. Most patients will present with a painful bulge in the groin, though up to a
third of patients will be asymptomatic at the time of diagnosis. Previously, it had been recommended that all
hernias be repaired surgically at the time of diagnosis to prevent the development of a hernia accident (bowel
obstruction or strangulation) that would require emergent surgery, which is associated with much higher morbidity
and mortality than an elective repair. However, several clinical trials have reported that risks of a hernia accident
are sufficiently low so that a “watchful waiting” (WW) approach for male patients who are asymptomatic or
minimally symptomatic is a safe management strategy. WW spares patients any risk of operative complications
related to their herniorrhaphy, perhaps the most significant of which is post-herniorrhaphy groin pain that has only
recently been appreciated as a significant issue. Although WW has now been proven to be safe in asymptomatic
males with an inguinal hernia, long-term results of randomized controlled trials have shown that most patients
initially managed with WW will eventually elect to have the hernia surgically repaired primarily due to increased
pain. The purpose of this article is to review the current evidence on watchful waiting for the management of
inguinal hernias.

Keywords: Inguinal hernia, watchful waiting, groin hernia, herniorrhaphy

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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