A randomized controlled study published in Ann Surg in September 2013 suggests that while watchful waiting is reasonable and safe for men with mildly symptomatic inguinal hernias, patients should be warned that inguinal hernia symptoms may progress and may eventually require surgical treatment. Fitzgibbons, a leading American hernia surgeon, and colleagues published their famous study in JAMA in 2006, which found that a watchful waiting strategy was an option for men with mildly symptomatic inguinal hernias, based on an average of 3.2 years of follow-up. The authors built on their previous study by conducting a further follow-up study of these patients. In the previous study, a total of 254 men with mildly symptomatic inguinal hernias were enrolled, and the watchful waiting date was December 31, 2004 (mean follow-up 3.2 years), at which time 81 patients (31.9%) were referred for surgical treatment. After an additional 7 years of follow-up (at least 11.5 years), K-M analysis showed that the cumulative incidence of conversion to surgery was estimated at 68%, with a significantly higher rate of conversion in patients over 65 years of age than in younger patients (79% vs. 62%). The most common reason for undergoing surgery was pain (54.1%), with a total of 3 patients requiring emergency surgery, but no deaths. Therefore, the authors concluded that both watchful waiting and elective surgical approaches are safe for mildly symptomatic inguinal hernias, but most patients will eventually present with clinical symptoms (mainly pain) and undergo surgery.