Category
Threshold Criteria
A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.
This policy covers the management of abdominal hernias including inguinal, femoral, umbilical, and incisional hernias, with criteria for referrals/treatment. The term ‘ventral hernia’ is a nonspecific term which could include umbilical, epigastric or incisional hernias, and therefore the more specific term must be used.
Eligibility
| LLR ICB will fund the treatment of abdominal hernias in the following circumstances ·        Hernias in female patients All suspected groin hernias in females should be referred due to the increased risk of incarceration/strangulation. ·        Inguinal hernias: Surgical treatment for asymptomatic or mildly symptomatic inguinal hernias in adults are NOT ROUTINLY FUNDED When symptoms are mild, the risk of complication is low. There is evidence that it is safe to manage asymptomatic inguinal hernias none operatively – watchful waiting. Garments such as hernia pants can provide support for patients with a hernia Patients should be referred if the meet the following criteria o  There is an inguinal –scrotal hernia o  It increases in size month to month o  Pain or discomfort significantly interferes with daily activities o  History of incarceration or real difficulty in reducing the hernia  ·        Femoral hernias: All suspected femoral hernias should be referred to secondary care due to the increased risk of incarceration/strangulation ·        Umbilical, Para-umbilical: Umbilical hernias appear as a painless lump in or near the navel. The majority will resolve by themselves. Umbilical hernias in children under 2 years of age will not be operated on until the third year of life. Indication for operative repair include o  Pain o  Incarceration o  Strangulation o  Defect larger than 1cm o  Skin ulceration o  Hernia rupture  ·        Epigastric hernias Epigastric hernias need to be clearly differentiated from divarication of the recti, which is a widening of the linea alba without a defect in the fascia. Patients should be referred if they meet the following criteria o  Hernia increasing in size o  Abdominal pain o  Nausea and vomiting  ·         Incisional hernia Asymptomatic incisional hernias do not need to be operated on. . Divarication of the recti  Surgical procedures are NOT commissioned.  A repair is not associated with good long-term results with an increased risk of incisional hernia. Consider physiotherapy. |
Guidance
| ARP 2. Review Date: 2027 |
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