Hernia Repair

Referral and Treatment Criteria applies – see RaTC - Elective hernia repair in adults (including use of biological meshes)

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Background

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.  This policy relates to four types of hernia:

  • Inguinal hernias occur in the groin; they are the most common type of hernia and mostly affect men
  • Umbilical hernias occur in the abdomen
  • Incisional hernias are iatrogenic; they occur through a previously made incision in the abdominal wall, normally a scar left from a previous surgical operation
  • Femoral hernias are an uncommon type of hernia; they occur in the groin. Unlike inguinal hernias, femoral hernias occur more frequently in women

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Hernia repair involves replacement and securing of the tissue or bowel back into the abdomen.  In some cases a mesh is placed over the hole and fixed using fine stitches to strengthen the area. Meshes can be either synthetic or biological.  A synthetic mesh consists of a polymer base but can vary in chemical composition.  Biological meshes can be derived from human, porcine or bovine tissue and be composed of dermal, pericardial or intestinal submucosa tissue.  The tissue is decellularised to leave a collagen matrix and some are chemically cross-linked

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Policy

Inguinal hernia repair

Surgical repair is not routinely funded for asymptomatic or mildly symptomatic inguinal hernias in adults. Adults should be referred for surgical assessment if they:

  • Demonstrate pain or discomfort significantly interfering with activities of daily living; AND meet at least one of the following:
    • A history of incarceration of, or real difficulty reducing, the hernia
    • An inguino-scrotal hernia
    • Increase in size month to month

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Umbilical hernia repair

Surgical repair is not routinely funded for asymptomatic or mildly symptomatic umbilical hernias in adults. Adults should be referred for surgical assessment if they:

  • Demonstrate pain or discomfort significantly interfering with activities of daily living; AND meet at least one of the following:
    • A history of incarceration of, or real difficulty reducing, the hernia
    • Increase in size month to month

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Incisional hernia repair

Surgical repair is not routinely funded for asymptomatic or mildly symptomatic incisional hernias in adults. Adults should be referred for surgical assessment if they have:

  • Pain/symptoms interfering with activities of daily living AND conservative management e.g. weight loss, has been tried first where appropriate

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Femoral hernia repair

People with femoral hernias should be referred for consultation

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Biological meshes

Biological meshes for hernia repair are not routinely funded by Kent and Medway CCGs for any patient group

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Refer also to the policy on Smoking status of patients prior to non-urgent surgery

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Patient Information Leaflets

  1. NHS Choices general hernia advice
  2. NHS Choices Inguinal Hernia Repair advice
  3. NHS Choices Femoral Hernia Repair advice

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Individual Funding Request form

Click here for the IFR Home page where you will be asked to register / log in to make an IFR application

For any queries please contact IFR Team on : 01732 375214 | ifr.southeast@nhs.net

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