Should surgeons repair symptomatic, clinically occult, radiologically evident, inguinal hernias? A case-control study of patient-reported outcomes.

Introduction: Patients who present with symptomatic, clinically occult, radiologically evident (SCORE) inguinal hernia represent diagnostic and therapeutic challenge with a wide differential diagnosis of groin pain. Often, diagnosis leads to surgical intervention despite the lack of evidence supporting this practice. This study evaluates patient-reported outcomes following surgical or conservative management of SCORE inguinal hernia.

Methods: Single-centre retrospective review of radiology database and general surgery outpatient booking system between 2017 and 2018 to identify SCORE hernia patients. Notes review to identify surgical and conservative management groups. Patient-reported outcomes determined using the validated EuraHS-QOL tool. Surveys sent to patients via post with follow-up telephone conversations between October 2019 and June 2020. Replies from the conservative and operative cohorts were compared.

Results: Total of 76 patients identified. 63 (83%) replies received and analysed (10 did not answer, 2 declined, 1 deceased). 32 in the surgical cohort and 31 in conservative management cohort. No statistically significant difference was there between cohorts in age, BMI, ASA, Charlson Comorbidity Index. No statistically significant difference was there in pain at the site of hernia (p = 0.535); restrictions of activities (p = 0.406); cosmetic discomfort (p = 0.289) in patient-reported outcomes between surgical and conservative cohorts.

Conclusion: There is no difference in pain, restriction to function or cosmesis in symptomatic clinically occult, radiologically evident inguinal hernia patients following either surgical or conservative management. A clear definition and further studies are essential to deliver better care for this population of patients.