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Hernia Repair (Adults) – Inguinal, Umbilical / Para-umbilical / Incisional / Femoral Hernia

  

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.


Hernia repair is commissioned as a Low Priority Procedure

ALL WOMEN with GROIN hernias should be referred

CCG commissioning position is that smaller hernias, giving few symptoms, especially wide necked hernias in more sedentary MEN are a low value treatment and many can be managed with GP watchful waiting.

Surgical repair of this type of hernia will therefore not usually be funded.

Treatment should only be given in line with these general principles.

Where patients are unable to meet these principles, in addition to the specific treatment criteria set out in this policy, funding approval may be sought from the CCG’s Individual Funding Request (IFR) Panel by submission of an IFR application

Surgical repair of symptomatic hernias may be supported for patients who meet the following criteria:

Symptomatic hernias in patients where symptoms are interfering with normal work, and/or normal domestic activities (activities of daily living) may be referred using appropriately completed LPP forms.

Description of problems should be documented in the referral letter.

Appropriate GP advice and support re weight management and smoking cessation is important and has the benefit of reducing symptoms / possible requirement for surgery, and making any subsequent surgery safer.

Management of Abdominal Hernia

Prior approval from the Clinical Commissioning Group will be required before any treatment proceeds in Secondary Care for:

  • Inguinal (groin) hernia
  • Umbilical and Para-umbilical hernia
  • Incisional hernia
  • Femoral hernia

Referral Criteria:

Inguinal Hernia Repair

  • Symptomatic i.e. symptoms are such that they cause significant functional impairment AND/OR
  • Hernia is difficult or impossible to reduce (i.e. history of incarceration or real difficulty reducing the hernia confirmed by ultrasound) AND/OR
  • Inguino-scrotal AND/OR
  • Increases in size month on month

Umbilical and Para-Umbilical Hernia Repair

  • Significant risk of incarceration or strangulation of the bowel hernia AND/OR
  • Experiencing pain/discomfort that causes significant functional impairment AND/OR
  • Increases in size month on month

Incisional hernia

  • Significant risk of incarceration or strangulation OR
  • Experiencing pain/discomfort that causes significant functional impairment and appropriate conservative management has been attempted first e.g. weight reduction where appropriate

Femoral hernia

  •  Patient has a suspected femoral hernia

Exception to policy

  • Patients who are under-going or plan to undergo peritoneal dialysis are not restricted by policy
  • Patients with suspected strangulated or obstructed inguinal hernia should be referred as an emergency
  • All inguinal hernias in children (<18 years) should be referred and to a paediatric provider
  • All groin hernias in women (inguinal and femoral) should be referred without prior authorisation due to increased risk of strangulation

 

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