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Hernias

Groin Hernia

 

All suspected femoral hernias should be referred to secondary care due to the increased risk of incarceration or strangulation.

 

All inguinal hernias should be considered for referral to secondary care. Patients with minimally symptomatic inguinal hernias who have significant comorbidity and do not want to have surgical repair can be managed conservatively in primary care.

 

Surgical Management of Inguinal Hernia

 

For asymptomatic or minimally symptomatic inguinal hernias in men, a watchful waiting approach is advocated including providing reassurance, pain management etc. under informed consent.

 

Refer for surgical treatment when one or more of the following criteria is met:

  • History of incarceration, difficulty in reducing the hernia or risk of strangulation.
  • Disabling pain or discomfort
  • Inguino-scrotal hernia
  • A hernia that is increasing in size month on month.
  • Suspected strangulated or obstructed hernia
  • Inguinal hernia in women

 

Umbilical Hernia

 

Refer for specialist advice and surgery when one or more of the following criteria is met:

  • Disabling pain or discomfort
  • A hernia that is increasing in size month on month.
  • If the patient is considered at risk of incarceration or strangulation.

 

Incisional Hernia

 

Refer for specialist advice and surgery when both of the following criteria are met:

  • Disabling pain or discomfort
  • Appropriate conservative management has been tried first e.g. weight reduction, smoking cessation where appropriate.