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All patients with a BMI greater than 30 should be encouraged to lose weight and referred to local weight management programmes where appropriate, prior to elective hernia repair; since obese patients may have an increased risk of post-operative complications following inguinal hernia repair. Obesity is also a risk factor for developing incisional and umbilical hernias and as a result recurrence rates may be higher in obese patients.
All patients should be encouraged to stop smoking and offered information on local smoking cessation support services prior to elective hernia repair; since smoking is a recognised risk factor for developing a hernia, as well as increasing the risk of recurrence and postoperative complications following surgical repair.
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.
For asymptomatic or minimally symptomatic inguinal hernias in men, a watchful waiting approach is advocated including providing reassurance, pain management etc. under informed consent.
Surgical treatment will only be routinely commissioned when one or more of the following criteria is met:
Referral for specialist advice and surgery, if appropriate, will only be routinely commissioned when one or more of the following criteria is met:
Referral for specialist advice and surgery, if appropriate, will only be routinely commissioned when both of the following criteria are met:
* Note: Significant functional impairment is defined as:
Surgical repair of divarication of recti/diastasis of abdominal muscle (without herniation) is not routinely funded.
Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.
Applications for consideration for funding approval should be sent to:
Alternatively, please send to: The Panel administrator at Bridge House, Collett Way, Newton Abbot, TQ12 4PH
Northern, Eastern and Western Devon Clinical Commissioning Group
South Devon and Torbay Clinical Commissioning Group
Date of publication: 25 July 2018