title: Management of asymptomatic inguinal hernia: a systematic review of the evidence.
abstract: OBJECTIVE
  To establish a literature-based surgical approach to asymptomatic inguinal hernia (IH).
  
  
  METHODS
  PubMed, the Cochrane Library database, Embase, national guidelines (including the National Library of Guidelines Specialist Library), National Institute for Health and Clinical Excellence guidelines, and the National Research Register were searched for prospective randomized trials comparing surgical treatment of patients with asymptomatic IH with conservative treatment.
  
  
  METHODS
  The literature search retrieved 216 article headlines, and these articles were analyzed. Of those studies, a total of 41 articles were found to be relevant and 2 large well-conducted randomized controlled studies that published their results in several articles were reviewed.
  
  
  METHODS
  The pain and discomfort, general health status, complications, and life-threatening events of patients with asymptomatic IH managed by surgery or watchful waiting were determined.
  
  
  RESULTS
  No significant difference in pain scores and general health status were found when comparing the patients who were followed up with the patients who had surgery. A significant crossover ratio ranging between 23% and 72% from watchful waiting to surgery was found. In patients with watchful waiting, the rates of IH strangulation were 0.27% after 2 years of follow-up and 0.55% after 4 years of follow-up. In patients who underwent elective surgery, the range of operative complications was 0% to 22.3% and the recurrence rate was 2.1%.
  
  
  CONCLUSIONS
  Both treatment options for asymptomatic IH are safe, but most patients will develop symptoms (mainly pain) over time and will require operation.
authors.affiliation: Department of General Surgery A, Haemek Medical Center, Sderot Yitshak Rabin, Afula 18101, Israel. hagarmizrahi@gmail.com
authors.forename: Hagar
authors.initials: H
authors.lastname: Mizrahi
authors.forename: Michael C
authors.initials: MC
authors.lastname: Parker
mesh_terms: D019468:Disease Management; D006304:Health Status; D006552:Hernia, Inguinal / Q000601:surgery / Q000628:therapy*; D006801:Humans; D010147:Pain Measurement; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D057832:Watchful Waiting