What effect does the duration of an inguinal hernia have on patient symptoms?

BACKGROUND: Despite the fact that repair of an inguinal hernia is one of th e most common operations performed in general surgery, we have very little information on the natural history of the untreated hernia. The aim of this study was to evaluate the association between hernia symptoms and the dura tion the patients had their hernias before presentation to a surgical outpa tient department for an elective or emergency operation. STUDY DESIGN: Data were gathered prospectively on a consecutive series of 6 99 patients admitted to two University Departments of Surgery for scheduled operations for an inguinal hernia. RESULTS: More than one third (267) of patients had their hernias for 1 year or longer, up to 65 years, before presentation. The most common symptom on presentation was pain or discomfort at the hernia site, which occurred in 457 (66%) patients. The cumulative probability of pain increased with time to almost 90% at 10 years. The hernia had become irreducible in 48 patients (6.9%). The cumulative probability of irreducibility increased from 6.5% ( 95% confidence interval 4% to 9%) at 12 months to 30% (95% confidence inter val 18% to 42%) at 10 years. Leisure activities were affected in 29% of pat ients although only 13% of patients had to take time off work because of he rnia-related symptoms. Only two patients (0.3%) required resection of infar cted bowel or omentum. CONCLUSIONS: Because many patients with an inguinal hernia are asymptomatic or mildly symptomatic, prospective clinical trials to assess the role of o perations for such hernias are required. (J Am Coll Surg 2001;193:125-129. (C) 2001 by the American College of Surgeons).