Criteria for referral to public hospital service

• Abdominal wall or groin hernia felt on examination, or that is clinically evident, that is affecting the person’s activities of daily living
• Femoral hernia
• Recurrence of a repaired hernia or previous hernia repair with new symptoms.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation, or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
• Findings on physical examination including position and size of the hernia
• Description of onset, nature, progression and duration of symptoms
• How symptoms are impacting activities of daily living, including impact on work, study, school or carer role
• Any relevant complications or comorbidities
• Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs).

Provide if available

• If referral relates to recurrence of a repaired hernia or previous hernia repair, details of previous hernia repair surgery including when and where procedures were performed
• If referral relates to incisional hernia, details of surgery including when and where the procedure was performed
• If referral relates to femoral hernia or a suspected symptomatic hernia that cannot be felt on examination, ultrasound report (including details of the diagnostic imaging practice).

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Note: there are also general surgery statewide referral criteria for hiatus hernia.

Where practicable patients with recurrence of a repaired hernia or new symptoms after a previous hernia repair should be directed to return to the surgeon, practice or health service where the surgery was performed.

Ultrasound imaging is not indicated for groin hernias with the exception of femoral hernias. MRI scans and CT imaging are not indicated.

Safer Care Victoria’s Best care guidance for Inguinal hernia repair for clinically unapparent groin hernia in adults note that inguinal hernia repair is not recommended for patients with minimal symptoms or for asymptomatic inguinal hernias that are small or only detectable by ultrasound.

Rectus diastasis is excluded as an indication for abdominoplasty in Victorian public hospitals. Referrals should be directed to a plastic surgery service that offers this procedure.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Referrals based on incidental findings found on imaging where the hernia is asymptomatic and not palpable
• Rectus diastasis as the only reason for referral.