REMEDY : BNSSG referral pathways

Hernias

Checked: 09-11-2018 by vicky.ryan Next Review: 01-11-2019

Principles of Management

Management of hernias in adults across BNSSG CCG is largely guided by the Hernia criteria based access policy.

Further information can be found at the following links:

Inguinal hernias (all inguinal hernias in women meet criteria for referral)

Femoral hernias (all femoral hernias meet criteria for referral)

If diagnosis is in doubt then a direct access USS can be requested on ICE.

Referral Guidance

All referrals for groin or abdominal hernias in adults must meet the referral criteria. If a referral does not clearly state how the criteria are met then it may be returned by the BNSSG Referral Service or the provider.

Criteria to access treatment must include the following:

  • History of an episode of incarceration of the hernia as evidenced in the patient’s primary care records OR

  • difficulty in reducing the hernia OR

  • a risk of strangulation OR

  • a) A progressive increase in size of hernia (month-on-month) as evidenced in the patient’s primary care records.

    AND

    b) Appropriate conservative management has been tried first, e.g. weight reduction where appropriate.

NOTE: All suspected Femoral & Inguinal hernias in female patients, and all suspected Femoral & Inguinal-scrotal hernias in male patients should be referred to Secondary Care due to the increased risk of incarceration/strangulation

Referral for hernias in children do not have to meet the same criteria and should be referred appropriately using the paediatric hernia guidelines.

 

Non-Surgical Management of Hernias

Local surgeons advise that non- surgical management of hernias that do not fulfil above criteria for referral can be safely managed with appropriate warnings. Patients should be advised about the risk of obstruction and incarceration. Episodes of pain or tenderness that are prolonged or severe would indicate emergency assessment for possible strangulation.

Non- surgical management of inguinal hernia may include use of a truss. However, evidence for their use is lacking and inappropriate use may cause complications so they are no longer recommended.

Trusses can be supplied and fitted in some pharmacies and disability aid outlets. A list of local suppliers is available (last updated in 2013)