Watchful waiting to surgery in men with mildly symptomatic or asymptomatic inguinal hernia: an individual participant data meta-analysis of long-term follow-up of randomized controlled trials.
Marcus Yeow, Alberto Aiolfi, Davide Lomanto, Sean Lee Kien Fatt, Sujith Wijerathne
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引用次数: 0
Abstract
Background: Individual studies on men with mildly symptomatic or asymptomatic inguinal hernia who have opted for watchful waiting (WW) vary considerably. Furthermore, long-term data on such patients who cross over to herniorrhaphy is scarce.
Methods: PubMed, EMBASE, and Cochrane databases were searched systematically from inception to 3rd April 2024 for long-term follow-up of randomized controlled trials (RCTs) on men with mildly symptomatic or asymptomatic inguinal hernia. Individual participant survival data of cross over rates from WW to herniorrhaphy were extracted, reconstructed and combined. Secondary outcome was reason for cross over to herniorrhaphy.
Results: Long-term follow-up of three RCTs with 592 participants was included. A total of 344/592 participants crossed over to herniorrhaphy during a median follow up period that ranged from 3.2 to 12.0 years. The median cumulative cross over rate was 54.2% (95% CI 45.5% - 66.3%). The cumulative 1-year, 5-year, and 10- year cross over rates were 28.7% (95% CI 25.2% - 32.5%), 51.5% (95% CI 47.4% - 55.6%), and 70.6% (95% CI 66.2% - 74.9%) respectively. During follow-up, the most frequent reasons for cross over to herniorrhaphy were increased pain 198/344 (57.6%) and incarceration 15/344 (4.4%).
Conclusion: This study provides valuable long-term data for patient counselling, indicating that while WW is a safe strategy for men with mildly symptomatic or asymptomatic inguinal hernia, symptoms would likely progress eventually, necessitating operative repair.
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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