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

医学 小心等待 无症状的 腹股沟疝 可视模拟标度 外科 荟萃分析 生活质量(医疗保健) 疝修补术 慢性疼痛 入射(几何) 物理疗法 内科学 物理 护理部 前列腺癌 癌症 光学
作者
Roberto Cirocchi,Gloria Burini,Stefano Avenia,Giovanni Domenico Tebala,Piergaspare Palumbo,Maria Chiara Cianci,Antonino Morabito,P. Bruzzone
出处
期刊:Anz Journal of Surgery [Wiley]
卷期号:92 (10): 2433-2441 被引量:7
标识
DOI:10.1111/ans.17594
摘要

The aim of this review is to compare the outcomes of surgical repair versus watchful waiting in asymptomatic or minimally symptomatic inguinal hernias.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.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].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.
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