This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Prognosis/ Outcomes  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Fitzgibbons and colleagues¹ compared watchful waiting with the surgical repair of minimally symptomatic inguinal hernia in men. However, they did not indicate how the outcomes may have differed between patients with direct and indirect inguinal hernias. The anatomy of the inguinal canal is important in this regard. Indirect inguinal hernias present through the internal inguinal ring and carry a significant risk of incarceration and/or strangulation. Direct inguinal hernias present through the floor of the inguinal canal and carry considerably less risk of complications.²

Even the putative mechanism for the development of these 2 types of inguinal hernias is different. The indirect type often occurs in young men and may be congenital in origin. The direct type tends to occur in older men and is caused by progressive weakening of the tissue structures.² It would therefore be valuable to know if the results of this trial differed . . . [Full Text of this Article]

Gardner W. Smith, MD
gwsmith@direcway.com
Deer Isle, Me

RELATED ARTICLES

Repair of Inguinal Hernia vs Watchful Waiting
Jean-Jacques Parienti
JAMA. 2006;295(23):2724.
EXTRACT | FULL TEXT  

Repair of Inguinal Hernia vs Watchful Waiting—Reply
Olga Jonasson and Robert J. Fitzgibbons
JAMA. 2006;295(23):2725.
EXTRACT | FULL TEXT  

Watchful Waiting vs Repair of Inguinal Hernia in Minimally Symptomatic Men: A Randomized Clinical Trial
Robert J. Fitzgibbons, Jr, Anita Giobbie-Hurder, James O. Gibbs, Dorothy D. Dunlop, Domenic J. Reda, Martin McCarthy, Jr, Leigh A. Neumayer, Jeffrey S. T. Barkun, James L. Hoehn, Joseph T. Murphy, George A. Sarosi, Jr, William C. Syme, Jon S. Thompson, Jia Wang, and Olga Jonasson
JAMA. 2006;295(3):285-292.
ABSTRACT | FULL TEXT