Hernia & Abdominal Wall
A practical referral guide for groin hernia, ventral and incisional hernia, rectus divarication and combined abdominal wall reconstruction.
1. Groin hernia
Typical presentation
Groin lump or swelling with discomfort, aching, pressure or pain during lifting, coughing or exercise.
Initial assessment
Clinical examination is often sufficient. Ultrasound can be useful when the diagnosis is uncertain.
symptomatic • enlarging • limiting activity • recurrent • diagnosis uncertain • femoral hernia suspected.
2. Ventral & incisional hernia
This includes umbilical, epigastric and incisional hernias.
Consider referral for
Symptoms • increasing size • recurrent hernia • previous mesh repair • multiple defects • significant abdominal wall weakness • concern about loss of domain or complexity of reconstruction.
Imaging
CT can be useful for larger, recurrent or complex abdominal wall hernias to define defect size, anatomy and previous repair.
3. Rectus divarication
Separation of the rectus muscles can cause central abdominal bulging and may contribute to reduced abdominal wall support or functional symptoms.
Initial management
Physiotherapy, core rehabilitation, weight optimisation and management of contributing factors may be appropriate initially.
Refer when
Persistent functional symptoms or significant bulging despite rehabilitation, associated hernia, or consideration of abdominal wall reconstruction.
4. Combined abdominal wall reconstruction
Some patients have a combination of hernia, rectus divarication, abdominal wall laxity and excess skin or soft tissue.
Consider referral when
Hernia or divarication coexists with significant redundant skin, previous major weight loss, post-pregnancy abdominal wall changes, scar distortion, or when the appropriate operative strategy is unclear.
Optimisation before abdominal wall surgery
Larger abdominal wall repairs may benefit from prehabilitation before surgery.
Weight optimisation
Individualised weight management, including modern medical weight-loss therapies where appropriate.
Nutrition
Adequate protein and nutrition to support healing and preserve lean muscle.
Strength & fitness
Improving conditioning before surgery rather than focusing on weight alone.
Medical risk factors
Smoking, diabetes and other modifiable risks should be optimised where possible.
Urgent assessment
A hernia that becomes suddenly painful, irreducible or associated with vomiting, abdominal distension, systemic illness or concern for bowel obstruction requires urgent hospital assessment rather than routine outpatient referral.
When to refer
Symptomatic
Pain, discomfort, functional limitation or progressive enlargement.
Complex
Recurrent hernia, previous mesh, multiple defects, large incisional hernia or significant abdominal wall weakness.
Combined problem
Hernia or divarication with redundant skin, weight-loss changes or potential need for combined reconstruction.
Uncertain
Refer when the diagnosis or the most appropriate management pathway is unclear.
Refer a patient
I am happy to assess patients where the optimal approach to hernia, rectus divarication or abdominal wall reconstruction remains uncertain.
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