Hernia Repair May Be Optional

This Reuters UK article cites a study published in today’s Journal of the American Medical Association which has interesting implications about the management of men with hernias that are causing only minimal symptoms. The standard of care until now has been to repair hernias as soon as they are diagnosed, fearing that delay may result in complications or the need for an emergency repair later. The study demonstrates that there is no harm in waiting until a hernia becomes more bothersome, and then operating only on the men whose symptoms are worse. Dr. David R. Flum, from the University of Washington in Seattle, predicted in a related editorial

“If the results of this study are reproduced in other populations and for other types of hernia, then the era of preventive hernia repair should go the way of prophylactic tonsillectomy, cholecystectomy [gallbladder removal], and appendectomy.”

I see this as a part of a larger trend away from surgical procedures as our knowledge increases. Surgeries for bleeding ulcers were more common before the discovery that many ulcers could be treated with antibiotics. Heart bypass surgery is becoming less frequent as cholesterol lowering medications help slow the progression of heart disease. It’s exciting to hope that as our understanding improves, other surgeries for which there is currently no adequate alternative, like joint replacement or spine surgery, will also be replaced by less invasive therapies.

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