Men with the most common type of hernia who are without pain may want to consider "watchful waiting" before opting for surgery, according to the January 18 issue of JAMA.

The study targeted middle-aged men with hernias near the groin known in medical jargon as "inguinal" hernias.

"Many men with inguinal hernia have minimal symptoms," writes lead author Dr. Robert Fitzgibbons, Jr., and colleagues. "Whether deferring surgical repair is a safe and acceptable option has not been assessed. Surgical repair, while generally safe and effective, carries long-term risk of hernia recurrence, pain, and discomfort."

An inguinal hernia occurs when tissue or part of the intestine protrudes through a weak portion of the abdominal wall, causing a tender bulge in the groin or scrotum. In the past, doctors believed that most people required surgery to avoid the danger of the tissue becoming trapped (or incarcerated), leading to gangrene.

Data from the recent study show, however, that the risk of hernia incarceration is minimal over a two-year period. In another key finding, men who opted for surgical repair reported similar levels of pain and discomfort as those who did not undergo hernia surgery.

In an accompanying editorial, Dr. David Flum from the University of Washington in Seattle writes: "Surgeons have been struggling for years to avoid the greatest harm in patients with incidentally identified hernia.

. . . Avoiding harm in this case is easy—it can best be accomplished by counseling and educating patients and only repairing hernias that cause symptoms."