What are the risks of not operating on a hernia?

Not every hernia requires immediate surgery. In some cases, especially when the hernia is asymptomatic and reducible, medical observation may be an option. The decision depends on the type of hernia, its size, symptoms, and the patient’s overall health conditions.

A hernia occurs when tissue or an organ protrudes through a weakened area of the abdominal wall. Without surgical correction, this opening does not spontaneously disappear. The hernia may remain stable, but it can also increase in size or begin to cause pain and discomfort.

One of the risks is incarceration (when the contents of the hernia become trapped). In this situation, the hernia can no longer be pushed back into the abdomen. Incarceration can cause pain and, depending on the organ involved, lead to intestinal obstruction.

A more severe complication is strangulation (interruption of blood flow to the tissue trapped within the hernia). When this occurs, the tissue can suffer damage due to lack of circulation. Strangulation is an emergency and requires immediate surgical evaluation and treatment.

Sudden and intense pain, vomiting, and a hernia that cannot be reduced back into the abdomen are warning signs. Changes in skin color over the hernia and abdominal distension also require prompt medical evaluation.

The risk of these complications varies according to the type of hernia. In men with asymptomatic inguinal hernias, observation may be a safe option in selected cases. The American College of Surgeons reports that incarceration occurred in less than 1% of men observed for more than two years without surgery.

The situation is different for other types of hernias. Femoral hernias carry a higher risk of incarceration and strangulation. For this reason, surgery is often considered even when symptoms are minor.

Umbilical hernias in adults can also present complications. According to the American College of Surgeons, an unoperated umbilical hernia has an approximately 4% risk of strangulation over five years. This number should not be applied to all types of hernias, as each location has different characteristics.

Incisional hernias, which appear in areas of previous surgeries, can also be observed in selected patients. The European Hernia Society guidelines report an acute event risk of 1.24% at one year and 2.59% at five years among patients with incisional hernias managed without surgery.

Beyond emergency situations, there is another reason to monitor the evolution of a hernia. It may increase in size and begin to cause pain or limit daily activities. In such cases, an initially asymptomatic hernia may then become an indication for surgical treatment.

The decision to operate on a hernia should consider the balance between the risk of leaving it uncorrected and the risks of the surgery itself. Not operating immediately may be an appropriate course of action for some patients, provided there is a medical indication and ongoing monitoring.

Patients with a hernia should undergo evaluation by a surgeon to identify the type of hernia and estimate individual risk. If intense pain, vomiting, or inability to reduce a hernia that previously returned to the abdomen occurs, evaluation should be sought urgently.