Policy number: SRP 059
Policy name: Hernia-Inguinal/Umbilical/Incisional/Ventral hernia repair (surgical treatment)
Status: Individual Prior Approval
Effective date: 1 April 2024
Next review date: 1 April 2026
This policy covers the management of inguinal, umbilical, ventral and incisional hernias, with criteria for referrals/treatment. This policy does not include hiatus hernia.
This policy does not include situations where emergency treatment is required e.g. strangulation is suspected-refer direct to secondary care
Femoral: All suspected femoral hernias should be referred to secondary care due to the increased risk of incarceration/strangulation
Mid and South Essex ICB commission surgical treatment on a restrictive basis for patients meeting the defined criteria below.
Inguinal:
For asymptomatic or minimally symptomatic hernias, a watchful waiting approach is advocated with informed consent.
Surgical treatment should only be offered when one of the following criteria is met:
- Symptomatic i.e. symptoms are such that they interfere with work or activities of daily living OR
- The hernia is difficult or impossible to reduce OR
- Inguino-scrotal hernia OR
- The hernia increases in size month on month OR
- The patient is currently asymptomatic but works in a heavy manual occupation (for e.g. in removal firms lifting heavy weights) and there is an increased risk of strangulation and future complications
Umbilical:
Surgical treatment should only be offered when one of the following criteria is met:
- Pain/discomfort severely impacting on activity of daily living with a demonstrable significant detrimental impact on daily activities with functional limitation OR
- Increase in size month on month OR
- To avoid incarceration or strangulation of bowel OR
- The patient is currently asymptomatic but works in a heavy manual occupation (for e.g. in removal firms lifting heavy weights) and there is an increased risk of strangulation and future complications
Incisional/Ventral:
Surgical treatment should only be offered when BOTH of the following criteria are met:
- Pain/discomfort severely impacting on activity of daily living with a demonstrable significant detrimental impact on daily activities with functional limitation.
AND
- Appropriate conservative management has been tried first e.g. weight reduction where appropriate.
OR
- The patient is currently asymptomatic but works in a heavy manual occupation (for e.g. in removal firms lifting heavy weights) and there is a risk of strangulation and future complications.
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Find out more information on applying for funding in exceptional clinical circumstances