Please click here to view the full Hernia Repair Commissioning Statement. 

Commissioning Position

Repair of suspected femoral hernias, inguinal hernias in women, or any irreducible hernias is commissioned and should be referred urgently due to the increased risk of incarceration/strangulation

Hernia repair for cosmetic reasons or for asymptomatic or minimally symptomatic hernias in adults is NOT routinely commissioned. An approach of watchful waiting is recommended for small painless hernias and supported by the evidence base; delaying repair is considered safe. Conservative management should be encouraged first e.g. to lose weight or try support from surgical appliances or suitable underwear.

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

• Pain/discomfort interfering significantly with activities of daily living
  OR
• The hernia is difficult to reduce
  OR
• Comorbidity which does not make the patient unfit for surgery at present but is like to significantly increase the risks associated with future surgery
  AND
• Where patients are willing to undergo surgery and are aware of the risks and benefits of surgery. To meet professional standard expectations¹⁴ and ensure patients are fully informed about options for treatment it is recommended that the RightCare inguinal-hernia shared decision-making aid⁴ and PROMs for hernia repair are discussed with patients prior to surgery.

For referral please use Check+ to check against referral criteria and generate Prior Approval Ticket if appropriate.

NHS Vale of York CCG does NOT routinely commission elective interventions on patients who have a BMI of 30 or above (classified as obese) or patients who are recorded as a current smoker – see commissioning statement 01. Optimising Outcomes from All Elective Surgery

To submit an application to the CCG's Individual Funding Request Panel, please click here for further information. Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes there is an exceptional clinical need that justifies deviation from the rule of this policy. Individual cases will be considered by the individual funding request panel.

• Patient information leaflets – general NHS hernia advice; inguinal hernias inguinal hernias; NHS inguinal hernia repair inguinal hernia repair

---