Non-surgical options

No surgery is really not a good option. Hernias never go away – they never heal themselves. Not with exercise, not with weight loss not with special injections - or anything else.

At best they stay the same, or enlarge slowly. At worst they enlarge rapidly, become very uncomfortable, and there is the risk of strangulation of the intestine.

In most cases they will gradually enlarge over time, but may suddenly get bigger in one big jump and drop down into the scrotum.

Or you find that one day the swelling doesn’t go away when you lie down – it remains as a swelling – that may be uncomfortable or really painful (see strangulation).

You may find that wearing a hernia belt or truss helps ease the discomfort, but it will never get rid of the hernia. Only surgery provides a permanent solution.

Is it a feasible option not to operate?

In 2004 two independent surgical teams one in Scotland, the other in USA decided to look into this question scientifically. They each set up a study which took men with an inguinal hernia and divided them into two groups. One group of men had an operation to fix the hernia – the other group were just observed – ‘watchful waiting’ - that is watching and waiting to see what happened if you did not operate. Or - do nothing until you run into trouble.

Watchful waiting – what happened?

The results at two years were published in the professional medical journals the Journal of the American Medical Association (JAMA) and in the Annals of Surgery in 2006

They were remarkably similar and showed that almost one-quarter of the non-operated patients ‘converted’ to surgery over the two year study.

What were the reasons for ‘conversion’? Increasing discomfort and pain, affecting everyday activities was the most common reason that patients assigned to the ‘no operation’ group asked to have their hernia repaired.

Professor O’Dwyer’s group in Scotland has just published the long term (mean 7.5 years) follow-up of these patients. His statement at the start of the discussion of this excellent study tell you all you need to know:-

This study has confirmed previous findings that most patients with minimal symptoms from an inguinal hernia develop pain over time. Pain was the most common reason for requesting operation, followed by effect on quality of life and increase in size of the hernia. Surgical repair is recommended for medically fit patients with a painless inguinal hernia.