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
Exception to policy
Patients who are under-going or plan to undergo peritoneal dialysis
All groin hernias in women (inguinal and femoral) should be referred without prior authorisation due to increased risk of strangulation
Included in policy
When symptoms are mild, the risk of complications is low.
There is evidence that it is safe to manage asymptomatic inguinal hernias non-operatively, i.e. with watchful waiting.
Patients with overt or suspected inguinal hernia causing significant discomfort and/or irreducible or partially irreducible inguinal hernia should be referred.
All children (<18 years) should be referred to a Paediatric provider for consultation.
Suspected strangulated or obstructed inguinal hernia should be referred as an emergency.
- Umbilical / Para-umbilical Hernia / Incisional Hernia Repair
- Surgical treatment is not commissioned unless there is significant risk of incarceration or strangulation.
- All femoral hernias should be referred to secondary care for a consultation.
Laparoscopic hernia repair
Laparoscopic hernia repair is commissioned ONLY for bilateral hernia or unilateral hernia repair where the patient has:
- Hernias with external swelling on clinical examination OR
- Recurrent hernia(s) (2 or more episodes within 6 months)