Abdominal hernia in adults

Lifestyle Management

All patients with a BMI greater than 30 should be encouraged to lose weight and referred to local weight management programmes where appropriate, prior to elective hernia repair; since obese patients may have an increased risk of post-operative complications following inguinal hernia repair. Obesity is also a risk factor for developing incisional and umbilical hernias and as a result recurrence rates may be higher in obese patients.

All patients should be encouraged to stop smoking and offered information on local smoking cessation support services prior to elective hernia repair; since smoking is a recognised risk factor for developing a hernia, as well as increasing the risk of recurrence and postoperative complications following surgical repair.

Groin Hernia

All suspected femoral hernias should be referred to secondary care due to the increased risk of incarceration or strangulation.

All inguinal hernias should be considered for referral to secondary care. Patients with minimally symptomatic inguinal hernias who have significant comorbidity and do not want to have surgical repair can be managed conservatively in primary care.

Surgical Management of Inguinal Hernia

For asymptomatic or minimally symptomatic inguinal hernias in men, a watchful waiting approach is advocated including providing reassurance, pain management etc. under informed consent.

Surgical treatment will only be routinely commissioned when one or more of the following criteria is met:

• History of incarceration, difficulty in reducing the hernia or risk of strangulation.
• Pain or discomfort sufficient to cause significant functional impairment*.
• Inguino-scrotal hernia.
• A hernia that is increasing in size month on month.
• Suspected strangulated or obstructed hernia.
• Inguinal hernia in women.

Umbilical Hernia

Referral for specialist advice and surgery, if appropriate, will only be routinely commissioned when one or more of the following criteria are met:

• Pain or discomfort sufficient to cause significant functional impairment*.
• A hernia that is increasing in size month on month.
• If the patient is considered at risk of incarceration or strangulation.

Incisional Hernia

Referral for specialist advice and surgery, if appropriate, will only be routinely commissioned when both of the following criteria are met:

• Pain or discomfort sufficient to cause significant functional impairment*
• Appropriate conservative management has been tried first e.g. weight reduction, smoking cessation where appropriate.

* Note: Significant functional impairment is defined as:

• Symptoms that result in an inability to sustain employment despite reasonable occupational adjustment, or act as a barrier to employment or undertake education.
• Symptoms preventing the patient carrying out self-care, maintaining independent living or carrying out carer activities.

Referral Instructions

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Applications for consideration for funding approval should be sent to:

Email: d-ccg.ifr-newsdt@nhs.net

Alternatively, please send to: The Panel administrator at Bridge House, Collett Way, Newton Abbot, TQ12 4PH

Please see Hernia Clinical Referral Guideline - Northern & Eastern

Patient Information

Accompanying clinical policy patient support information for the hernia policy

Individual Funding Request (IFR) Patient information leaflet

Pathway Group

Northern, Eastern and Western Devon Clinical Commissioning Group South Devon and Torbay Clinical Commissioning Group

Date of publication: 10 September 2015