Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe

Due to risks of postoperative morbidity and recurrence some patients with a ventral hernia are not offered surgical repair. There is limited data on the rate and consequences of a watchful waiting (WW) strategy for these patients. The objective of this cohort study was to analyse outcomes for patients with a ventral hernia who underwent watchful waiting, in terms of later requirement for hernia repair.

All patients (≥18 years) electively referred to our out-patient clinic from 1 January 2009 to 1 July 2014 with incisional, umbilical or epigastric hernia were included. Information on patient characteristics and whether patients underwent WW or surgery was obtained from hospital files and the Danish National Patient Register. A 100% follow-up was obtained.

The analyses comprised 569 patients with incisional hernia (WW = 58.1%) and 789 patients with umbilical/epigastric hernia (WW = 43.2%). Kaplan-Meier analyses estimated that the probability for patients who underwent watchful waiting to receive later surgical repair was 19 for incisional hernias and 16% for umbilical/epigastric hernias after 5 years. The probability of requiring emergency repair when in the WW group was 4% for both incisional and umbilical/epigastric hernias after 5 years. There were no significant differences in 30-day readmission, reoperation or mortality rates between the WW patients who later underwent elective hernia repair and patients who were initially offered surgery (p > 0.05), for both incisional and umbilical/epigastric hernias.

Watchful waiting appears to be a safe strategy in the treatment of incisional, umbilical and epigastric hernias.