Surgical endoscopy
October 20, 2026 · via Europe PMC
Long-term follow-up in asymptomatic or oligosymptomatic inguinal hernias: watchful or watchless waiting?
Valinoti AC, Aramburu S, Principe J, Giacone JA, Sadava EE.
AI summary — for doctors, generated from the abstract only
Watchful waiting for minimally symptomatic inguinal hernia looks safe, but most patients stop attending follow-up, especially younger ones.
What was studied
Retrospective cohort of 400 patients in a hernia watchful-waiting protocol (2013 onward) with scheduled visits, and a structured questionnaire sent to those lost to follow-up.
Key findings
- 60% (240) of patients did not keep up scheduled surveillance, with progressive dropout over time
- Discontinuation was highest under age 30 (92.9%) vs 30-50 (63.6%) and over 50 (56.4%)
- Main reasons: no symptoms (36%) and unawareness of follow-up intervals (27%)
- No emergency surgery among those followed or contacted; 14.1% of respondents had elective repair elsewhere
Clinical relevance
Watchful waiting depends on follow-up that patients rarely sustain, so counselling and recall systems matter.
Who should care
Limitations
Retrospective with only 32% survey response among those lost, so events in non-responders are unknown.
When offering watchful waiting, explicitly educate on warning signs and follow-up intervals, particularly in younger patients.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Watchful waiting (WW) for inguinal hernia has been established as a safe strategy for selected patients. However, this approach relies on regular long-term follow-up and adherence rates to WW are poorly characterized.
Methods
A retrospective cohort study was performed including patients with inguinal hernia enrolled in a WW surveillance protocol between May 2013 and May 2026. Follow-up visits were scheduled every 6 months during the first year and annually thereafter. Demographic, clinical, and long-term adherence to surveillance protocols were analyzed Patients who were lost to follow-up were contacted via a structured questionnaire to update their clinical status and identify causes for discontinuing protocol.
Results
A total of 400 patients were included in the WW protocol. Overall follow-up adherence was low, with 240 patients (60.0%) failing to maintain scheduled surveillance at the end of this study. Kaplan-Meier analysis demonstrated a progressive drop out of the protocol over time. Younger age was an independent factor associated with follow-up discontinuation. Patients younger than 30 years demonstrated the highest rate of surveillance discontinuation (92.9%), compared with 63.6% among patients aged 30-50 years and 56.4% among patients older than 50 years (p = 0.015). Seventy-seven (32%) responded to the survey; the most frequent causes for discontinuation were the absence of symptoms and the lack of awareness of recommended follow-up intervals (36% and 27%, respectively). Eleven patients (14.1%) had an elective hernia repair at another institution. No emergency surgery was identified among patients who remained under institutional follow-up or among those successfully contacted after surveillance discontinuation.
Conclusions
Watchful waiting appears to remain an acceptable management strategy for selected patients with asymptomatic or oligosymptomatic inguinal hernia. However, long-term adherence to surveillance beyond 2 years is low, posing a significant limitation to sustained WW management.
DOI
10.1007/s00464-026-13475-0
PMID
42902005
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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