The above flow chart is for GPs who have a patient with a Groin Hernia for whom referral is appropriate. In some cases, GP and patient may decide that referral is not the best option for the patient.
The flow chart refers to ASA Categories. These are used to provide general information regarding a patient’s fitness to undergo an anaesthetic based on the patient’s comorbidities that are known to the GP. The GP is not being asked to undertake an anaesthetic assessment. All patients who are to have surgery will go through the appropriate pre-operative assessment in secondary care, including attendance at pre-operative clinic and anaesthetic assessment where appropriate.
| Category | Description |
| ASA 1 | A normal healthy patient |
| ASA 2 | A patient with mild systemic disease (Their comorbidity does not limit their activity) |
| ASA 3 | A patient with severe systemic disease (Their comorbidity does limit their activity) |
| ASA 4 | A patient with severe systemic disease that is a constant threat to life |
More information on ASA categories can be found on https://www.asahq.org/standards-and-guidelines and there are further resources under Resources and Links to tools that GPs may find helpful when discussing with a patient their fitness for surgery. In some situations the ASA category will not be clear and this can be outlined in the referral text.
A patient information leaflet created by General Surgery is available under Primary Care Management
R.C 06-03-23
Who can refer:
GPs and ANPs working in Primary Care
Who to refer:
Male and female patients with inguinal or femoral hernias as per the flowchart above.
Who not to refer via these pathways:
Patients with symptoms of obstruction or a strangulated hernia – these patients should have an emergency same day referral to secondary care
Patients with other types of hernia not covered by the pathway above – these patients should be referred to General Surgery via a Basic Sign Referral
How to refer:
Please refer via SCI Gateway
For unilateral groin hernias in men from GP practices in the North of Edinburgh referrals can be sent to Colorectal at the WGH via the pathway:
WESTERN GENERAL HOSPITAL >> GENERAL SURGERY – COLORECTAL >> LI BASIC COLORECTAL REFERRAL
For all other referrals within Lothian as per the pathway above referrals should be sent to General Surgery at the RIE via the pathway:
ROYAL INFIRMARY OF EDINBURGH >> GENERAL SURGERY >> LI HERNIA DIRECT
