Inguinal hernia: challenging the traditional indication for surgery in asymptomatic patients.
BACKGROUND
It is generally accepted that most inguinal hernias should be operated on electively in order to avoid the high morbidity and mortality associated with incarceration and small bowel obstruction. The present study reassesses the indication for surgery in asymptomatic inguinal hernia patients.


METHODS
We analyzed profiles, separately, for elective and emergency inguinal herniorrhaphies and compared the morbidity and mortality rates.


RESULTS
Two hundred randomly selected elective hernia repairs were compared with 67 incarcerated cases. Postoperative complications were more common following emergency (23.9%) than elective repair (10.5%); however, in both groups, minor complications predominated. The mortality rate in the incarcerated group (6%) was clearly linked with a high preoperative American Society of Anesthesiologists (ASA) score. A bowel resection rate of 4.5% was found in the incarcerated cases, which was not correlated with mortality.


CONCLUSIONS
Patients with asymptomatic inguinal hernia and unfavorable medical conditions should be recommended an elective repair, preferably under local anesthesia, to avoid the high mortality associated with an emergency operation.
Ohana
Gil
G
Division of Surgery Golda Campus Rabin Medical Center Petach Tiqva Affiliated with The Sackler School of Medicine, Tel Aviv University, Israel. gil_oha@inter.net.il
Manevwitch
Igor
I
Weil
Ruben
R
Melki
Yedidia
Y
Seror
Dan
D
Powsner
Eldad
E
Dreznik
Zeev
Z
D000368:Aged; D017558:Elective Surgical Procedures; D004630:Emergencies; D006552:Hernia, Inguinal / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D007421:Intestine, Small; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate