The effect of watchful waiting on the management and treatment of inguinal hernias in a community setting

• Published in: The American surgeon 2015-03, Vol.81 (3), p.300-304
• Main Authors: Williams, Zachary F, Mulrath, Alexa, Adams, Ashley, Hooks, 3rd, W Borden, Hope, William W
• Format: Article
• Language: English
• Subjects: Directive Counseling; Health Care Surveys; Hernia, Inguinal - therapy; Hernias; Humans; Imprisonment; Pain; Patient Participation; Patient Selection; Patients; Physicians; Polls & surveys; Practice Patterns, Physicians; Prostate cancer; Referral and Consultation; Response rates; Strangulation; Studies; Surgery; Watchful Waiting
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481508100334

A landmark study by Fitzgibbons et al. reported the safety of watchful waiting in men with minimally symptomatic inguinal hernias. The extent to which this study has changed practice patterns is unknown. The purpose of our study was to survey physicians caring for patients with hernia in our community to determine if the Fitzgibbons report impacted their medical practices. We sent an electronic survey containing questions regarding physician background and familiarity with the 2006 New England Journal of Medicine report on watchful waiting to physicians in our community. The online survey was accessed by 77 physicians; 74 completed the survey. Of 74 participants, surgeons accounted for 15 per cent, family/internal medicine 42 per cent, and 13 other specialties 43 per cent. Nonsurgeons were less familiar with the Fitzgibbons report. All surgeons had heard of the study, and 73 per cent had read it compared with 3 per cent of nonsurgeons. In nonsurgeon physicians, 38 per cent preferred letting patients with inguinal hernia decide treatment after counseling, 30 per cent sent all patients to a surgeon, and 25 per cent sent only symptomatic patients to a surgeon. Surgeons let patients decide after counseling in 73 per cent and chose watchful waiting for asymptomatic patients/offered surgery to symptomatic patients in 27 per cent. Based on our survey, Fitzgibbons' watchful waiting report does not appear to have significantly impacted practice and referral patterns in our community, although the watchful waiting strategy outlined in the study is practiced. Our study illustrates the challenge of translating research outcomes into clinical practice. Further research on ways to disseminate important surgical information to nonsurgeons seems warranted.