Management of Asymptomatic Hernia Found on Physical Examination

Initial Assessment and Management Decision

• Patients with asymptomatic hernias should be educated to recognize symptoms of hernia incarceration or strangulation, which would necessitate prompt surgical evaluation, as recommended by the American College of Surgeons 1, 2

Risk Stratification for Watchful Waiting

• Patients planning peritoneal dialysis should consider surgical repair despite being asymptomatic, according to the American Society of Nephrology 1
• Large hernia defects with risk of progression should consider surgical repair, as suggested by the European Hernia Society 2

Special Considerations

• For patients with asymptomatic abdominal wall hernias and severe kidney enlargement, nonsurgical management should be strongly considered due to increased risk for complications associated with repair and potential hernia recurrence, as recommended by the National Kidney Foundation 1

Monitoring During Watchful Waiting

• Patients should be instructed to seek immediate medical attention if they develop acute pain at the hernia site, irreducibility of the hernia, signs of bowel obstruction, or systemic inflammatory response syndrome, as advised by the World Society of Emergency Surgery 2

When to Consider Surgical Intervention

• Difficulty in reducing the hernia is an indication for surgical intervention, as recommended by the European Association for Endoscopic Surgery 2