Hernia for patients aged 18 and over (Bulging of tissue through a weak spot in the muscle)

Threshold

Norfolk and Suffolk Integrated Care Board (ICB) will fund hernia procedures, including treatment in tertiary care for complex procedures, as listed below:

Inguinal:

Diagnosis of inguinal hernias can be made through clinical history and examination; routine ultrasound is not required for diagnosis.

For asymptomatic or minimally symptomatic hernias, a watchful waiting approach, under informed consent, is advocated.

Surgical treatment should only be offered when one of the following criteria is met:

• symptoms of pain or discomfort that interfere with activities of daily living,
  OR
• the hernia is difficult or impossible to reduce,
  OR
• it is an inguino-scrotal hernia,
  OR
• the hernia increases in size month on month.

Femoral:

• Unless otherwise indicated, all suspected femoral hernias should be referred to secondary care due to the increased risk of incarceration/strangulation.

Umbilical/Paraumbilical:

Surgical treatment should only be offered when one of the following criteria is met:

• symptoms of pain or discomfort that interfere with activities of daily living,
• the hernia is difficult or impossible to reduce,
• the hernia increases in size month on month.

Incisional (Including parastomal):

• Surgical treatment should only be offered when there are symptoms of pain/discomfort that interfere with activities of daily living.

Spigelian Hernias:

• All suspected spigelian hernias should be referred to secondary care due to the increased risk of incarceration / strangulation.

Inguinal Disruption (Sportsman’s Hernia/Gilmore’s groin):

Not routinely funded.

Diastases/Divarication of Recti:

Diastases/Divarication of recti is a separation between the left and right side of the rectus abdominis muscle and causes a protrusion in the midline but is not a ‘true’ hernia and does not carry the risk of bowel becoming trapped within it and thus does not require repair. The Norfolk and Suffolk ICB consider repair of divarication of recti as a cosmetic procedure and a low priority. Evidence suggests that divarication does not carry the same risks as that of actual herniation.

Cases for Individual Consideration 

On a case to case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.