Evidence map›Paper›PMID 41284063›Full record

SynthesisHernia : the journal of hernias and abdominal wall surgery2025

Watchful waiting vs. early repair for asymptomatic and mildly symptomatic inguinal hernia - silent hernia, loud debate: a qualitative systematic review.

Marina Eguchi, Thiago Souza E Silva Silva, Elisa Guimarães Forchezatto, Yasmin Biscola da Cruz, Vitor Neves, Denise Padilha, Diego Camacho, Leandro Totti Cavazzola, Diego L Lima

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Hernia : the journal of hernias and abdominal wall surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Marina EguchiDepartment of Surgery, Federal University of São Paulo, 740 Botucatu St, São Paulo, SP, 04023-062, Brazil.
Thiago Souza E Silva SilvaReal Instituto de Cirurgia Oncológica, Real Hospital Português de Beneficência Em Pernambuco, 4760 Av. Gov. Agamenon Magalhães, Recife, PE, 52010-075, Brazil.
Elisa Guimarães ForchezattoPontifical Catholic University of Paraná - PUCPR, 1155 Imaculada Conceição St, Curitiba, PR, 80215-901, Brazil.
Yasmin Biscola da CruzUniversidade Federal Do Paraná - UFPR, Rua Padre Camargo, 285, Alto da Glória, Curitiba, PR, 80060-240, Brazil.
Vitor NevesHospital Universitário Pedro Ernesto - UERJ, Boulevard 28 de Setembro 77, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil.
Denise PadilhaCentro Universitário Cesmac, 918 Cônego Machado St, Maceió, AL, 57051-160, Brazil.
Diego CamachoDepartment of Surgery, Montefiore Medical Center, 1825 Eastchester Rd, Bronx, NY, 10461, USA.
Leandro Totti CavazzolaDepartment of Surgery, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil.
Diego L LimaDepartment of Surgery, Montefiore Medical Center, 1825 Eastchester Rd, Bronx, NY, 10461, USA. dilaurentino@gmail.com.ORCID 0000-0001-7383-1284

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimMore than one-third of inguinal hernias are asymptomatic, and performing surgery in the absence or presence of mild symptoms remains a point of concern for many surgeons. This study aims to evaluate whether watchful waiting (WW) is a viable management strategy for asymptomatic and mildly symptomatic inguinal hernias by comparing its outcomes to early surgical repair. To broaden the scope of existing evidence, we included both recent randomized controlled trials and observational studies. MATERIAL AND

methodsPubMed, Cochrane Central, and EMBASE were searched for studies comparing early repair and WW in patients with asymptomatic or mildly symptomatic inguinal hernias. The primary outcomes assessed were the rate of crossover from WW to surgery, reasons for crossover, and the presence of pain in both groups. Secondary outcomes included quality of life (QoL) and hernia recurrence. A Kaplan-Meier failure function curve was constructed to estimate time from study enrollment to crossover.

resultsAmong 619 screened studies, 12 met the inclusion criteria, covering 1,755 patients (748 (42.6%) in early surgical intervention and 1,007 [57.4%] in the WW). Among WW patients, 477 (27.1%) eventually crossed over to surgery, with crossover rates ranging from 6.1% (Patti 2014) to 75.4% (Chung 2011). Approximately 50% of WW patients required surgery within five years. The most reported reason for crossover was pain (65%), followed by impaired quality of life (16%), bowel-related symptoms such as incarceration or strangulation (8.5%), hernia volume progression (3%), and other or unspecified causes (7.5%). Pain was the most consistent patient-specific predictor of crossover to surgery.

conclusionWW appears to be a viable and safe approach with low complications rates for patients with asymptomatic inguinal hernias. However, long-term data show that approximately 50% of patients cross over to surgery within five years, and this proportion exceeds 96% by 12 years. Ultimately, the decision between WW and early surgical intervention should be guided by shared decision-making, considering patient values, symptom burden, comorbidities, and life expectancy.

Indexed as

Hernia, InguinalHerniorrhaphyWatchful WaitingAsymptomatic DiseasesHumansQuality of LifeRecurrenceTime-to-TreatmentInguinal herniaSystematic reviewWatchful waiting

Identifiers

PMID41284063

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.