Hernia

What is a hernia?

A hernia is when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.

A hernia usually develops between the chest and hips. In many cases, it causes no or very few symptoms, although the patient may notice a swelling or lump in the tummy (abdomen) or groin. The lump can often be pushed back in or disappears when laid down. Coughing or straining may make the lump appear.

Umbilical hernias happen when fatty tissue or a part of the bowel pokes through the abdomen near the belly button (navel). This type of hernia can occur in babies if the opening in the tummy through which the umbilical cord passes doesn't seal properly after birth and over time, can heal by itself.

Adults can also be affected, possibly as a result of repeated strain on the abdomen and are more likely to need surgery to fix it.

A para-umbilical hernia is different to an umbilical hernia in that these hernias may become very large. They are more common in adults (especially women who have had more than one pregnancy), than children and happens because of a defect in the linea alba, which is the tendon-like tissue that lines the wall of the tummy.

An incisional hernia is where tissue pokes through a surgical wound in the tummy that hasn't fully healed.

Treatment

Advances in surgery and post-operative care have meant that clinical research has been done to look at the benefits to the patient of the different surgical approaches and which is the best is the safest.

The types of surgical repairs have included:

  • Laparoscopic approach - during keyhole surgery, the surgeon usually makes three small incisions in your abdomen instead of a single larger incision.
  • ‘Open repair’ approach- the surgeon makes a single cut (incision). This incision is usually about 6 to 8cm long.

However, the evidence currently available shows that laparoscopic surgery, where clinically appropriate, is preferable due to the significantly reduced rates of surgical site infection and should be the preferred choice.

Patient eligibility criteria

This policy is for the management of umbilical, para-umbilical and incisional hernias in adult patients.

Strangulated umbilical, para-umbilical or incisional hernias should proceed to the most clinically appropriate surgery in a timely manner

For non-urgent procedures, the patient must be diagnosed with a *symptomatic umbilical, para-umbilical or incisional hernia

The patient should be reviewed by the surgical clinician and in a shared decision-making process with the patient; a decision should be reached as to the most clinically effective method of surgery for the individual patient (either laparoscopic or open surgery).

* For the purposes of this policy, symptomatic hernia is defined described as 'debilitating pain which impacts on activities of daily living, e.g. walking; sleeping; working.’

This means (for patients who DO NOT meet the above criteria) the CCG will only fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need and that is supported by the CCG.

Advice and guidance

  • For more information, search for ‘hernia’ at www.nhs.uk 
  • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

Treatment policy for patients covered by NHS Birmingham and Solihull CCG