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A hernia usually presents as a lump, and patients often experience pain or discomfort that can limit daily activities and the ability to work. In addition, hernias can present as a surgical emergency should the bowel strangulate or become obstructed due to the hernia.
This guidance covers all abdominal hernia; a link to the NHS Devon Hernia policy is available here.
Please note pre-referral criteria are applicable in this referral.
To see information required please see Referral Section, referrals submitted without this information will be returned.
Please note primary care is requested to follow In Shape for Surgery best practice which can be seen here.
A hernia is defined as a protrusion of an organ or tissue out of the body cavity in which it normally lies, through the structures normally containing it.
They usually present as a lump, and patients often experience pain or discomfort that can limit daily activities and the ability to work.
Very rarely, hernias can present as a surgical emergency e.g., should herniated bowel strangulate or become obstructed due to the hernia.
Evidence suggests that overweight or obese patients have an increased risk of postoperative complications including infection and severe pain following groin hernia surgery. Obesity has also been associated with the development of umbilical and incisional hernias as well as an increased risk of recurrence following surgical repair of incisional hernias.
Smoking is a recognised risk factor for both the development and recurrence of inguinal hernias and is thought to contribute to the development of incisional hernias. Evidence suggests there is an increased risk of postoperative complications following inguinal hernia surgery, in patients who smoke.
Information on employment is always useful. Specific roles do increase the risk of developing a hernia. This information is also useful when assessing significant functional impairment, which is part of some of the referral criteria.
NHS Devon no longer commissions ultrasound for the diagnosis of groin hernia.
No treatment is required for asymptomatic or minimally symptomatic hernias, except femoral hernias which should be referred as there is a higher incidence of strangulation. In women, these should be referred urgently.
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; 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.
In women all groin hernias should be urgently referred to secondary care due to the increased risk of incarceration or strangulation.
In men all femoral hernias should be referred to secondary care and all inguinal hernias should be considered for referral to secondary care.
Men with minimally symptomatic inguinal hernias who have significant comorbidity and do not want to have surgical repair can be managed conservatively in primary care.
For asymptomatic or minimally symptomatic inguinal hernias in men, a watchful waiting approach is advocated including providing reassurance, pain management etc. under informed consent.
Referral for specialist advice and surgery, if appropriate, will only be routinely commissioned when one or more of the following criteria is met. Referrals submitted without this information will be returned:
Referral for specialist advice and surgery, if appropriate, will only be routinely commissioned when both of the following criteria are met, referrals submitted without this information will be returned:
* Note: Significant functional impairment is defined as:
Surgical repair of divarication of recti/diastasis of abdominal muscle (without herniation) is not routinely funded.
Other hernias
Please note primary care is requested to follow In Shape for Surgery best practice which can be seen here.
Refer using e-Referrals
MyHealth patient information - Hernia
Hernia Surgery in Adults - Cambridgeshire and Peterborough CCG
This guideline was signed off by the NHS Devon Clinical Pathway Group.
Publication date: December 2016
Updated date: August 2024