Just to be clear, my 3" leather belt fully covers the hernia. I thought the purpose of the velcro belt is to cover the area of the hernia when the leather belt doesn't.
The advice I was given years ago was do nothing if there are no symptoms (e.g. pain, digestive issues, swelling, etc), which is basically what I did. Had it for years, and probably had "pain" twice a year, totally randomly, and not directly related to training, but definitely coming directly from the hernia. Recently, I have had more occurrences of pain, which could be the hernia getting larger, or associated with the digestive tract getting caught in the hernia (which could turn out to be a very bad situation). Therefore, surgery is recommended.
The surgeon I just saw said that whether or not one will ever have an issue requiring repair depends in part on what kind of tissue is pushing through the hernia. If it's just fatty tissue, it may never cause pain. They don't really know for sure what kind of tissue is there until they do the surgery.