{"id":28317,"date":"2026-06-12T11:04:20","date_gmt":"2026-06-12T10:04:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=28317"},"modified":"2026-06-17T14:49:48","modified_gmt":"2026-06-17T13:49:48","slug":"groin-hernia","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/groin-hernia\/","title":{"rendered":"Groin Hernia"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">There is guidance on this page for assessment and, where appropriate, referral for Groin Hernia. Please see the link above for information on assessment for Abdominal Hernia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div data-wp-interactive=\"core\/file\" class=\"wp-block-file\"><object data-wp-bind--hidden=\"!state.hasPdfPreview\" hidden class=\"wp-block-file__embed\" data=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/General-Surgery-Groin-Hernia-Flowchart-FINAL-June-26.pdf\" type=\"application\/pdf\" style=\"width:100%;height:600px\" aria-label=\"Embed of General Surgery Groin Hernia Flowchart FINAL June 26.\"><\/object><a id=\"wp-block-file--media-1a1888cb-161d-4720-9043-297ef812ff40\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/General-Surgery-Groin-Hernia-Flowchart-FINAL-June-26.pdf\">General Surgery Groin Hernia Flowchart FINAL June 26<\/a><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/General-Surgery-Groin-Hernia-Flowchart-FINAL-June-26.pdf\" class=\"wp-block-file__button wp-element-button\" download aria-describedby=\"wp-block-file--media-1a1888cb-161d-4720-9043-297ef812ff40\">Download<\/a><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>ASA Categories and Frailty Assessment<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The flowcharts above refer to ASA Categories. These&nbsp;are used to provide general information regarding a patient&#8217;s fitness to undergo an anaesthetic based on the patient&#8217;s comorbidities that are known to the GP. &nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>The GP is <strong>not<\/strong> 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<\/u>.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Category<\/strong><\/td><td><strong>Description<\/strong><\/td><\/tr><tr><td>ASA 1<\/td><td>A normal healthy patient<\/td><\/tr><tr><td>ASA 2<\/td><td>A patient with mild systemic disease &nbsp;(Their comorbidity does not limit their activity)<\/td><\/tr><tr><td>ASA 3<\/td><td>A patient with severe systemic disease <a><\/a>(Their comorbidity does limit their activity)<\/td><\/tr><tr><td>ASA 4<\/td><td>A patient with severe systemic disease that is a constant threat to life<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">More information on ASA categories can be found <a href=\"https:\/\/www.asahq.org\/standards-and-guidelines\/asa-physical-status-classification-system\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a> and there are further resources under <strong>Resources and Links<\/strong> 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For Frailty assessment of patients over the age of 65 then it is recommended that referrers use the Rockwood Frailty score. A summary of this is available in the <strong>Resources and Links <\/strong>section.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A patient information leaflet created by General Surgery is available under <strong>Resources &amp; Links <\/strong>re Groin Hernia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>J.B &amp; R.M &#8211; 12-06-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">GPs and ANPs working in Primary Care<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">As per the flowchart above<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer via these pathways<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with symptoms of obstruction or a strangulated hernia \u2013 these patients should have an emergency same day referral to secondary care<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with other types of hernia not covered by the pathway above \u2013 these patients should be referred to General Surgery via a Basic Sign Referral<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Please refer via SCI Gateway.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please follow the flowchart above for which site patients can be referred to.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For RIE and SJH referrals the referral pathway is:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>RIE &gt;&gt; GENERAL SURGERY &gt;&gt; LI HERNIA DIRECT<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">OR<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>SJH &gt;&gt; GENERAL SURGERY &gt;&gt; LI HERNIA DIRECT<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Where referral to the WGH is appropriate the referral pathway is:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>WGH &gt;&gt; GENERAL SURGERY \u2013 COLORECTAL &gt;&gt; LI BASIC COLORECTAL REFERRAL<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/journals.lww.com\/anesthesiologyopen\/fulltext\/2026\/04000\/american_society_of_anesthesiologists_statement_on.2.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">ASA Physical Status Classification System<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/riskcalculator.facs.org\/RiskCalculator\/index.jsp\" target=\"_blank\" rel=\"noreferrer noopener\">ASA Risk Calculator<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MoE-HatH-Rockwood-Clinical-Frailty-Scale-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Rockwood Clinical Frailty Scale<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Inguinal-hernia-patient-information-leaflet-1-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Inguinal hernia patient information leaflet<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>There is guidance on this page for assessment and, where appropriate, referral for Groin Hernia. Please see the link above for information on assessment for Abdominal Hernia. ASA Categories and Frailty Assessment The flowcharts above refer to ASA Categories. These&nbsp;are used to provide general information regarding a patient&rsquo;s fitness to undergo an anaesthetic based on<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[660,1399],"class_list":["post-28317","page","type-page","status-publish","hentry","category-generalsurgery","category-https-apps-nhslothian-scot-refhelp-groin-hernia"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/surgery\/generalsurgery\/\" rel=\"tag\">General Surgery<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/surgery\/generalsurgery\/https-apps-nhslothian-scot-refhelp-groin-hernia\/\" rel=\"tag\">Groin Hernia<\/a>","rttpg_excerpt":"There is guidance on this page for assessment and, where appropriate, referral for Groin Hernia. Please see the link above for information on assessment for Abdominal Hernia. ASA Categories and Frailty Assessment The flowcharts above refer to ASA Categories. These&nbsp;are used to provide general information regarding a patient&rsquo;s fitness to undergo an anaesthetic based on","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28317","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=28317"}],"version-history":[{"count":5,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28317\/revisions"}],"predecessor-version":[{"id":28357,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28317\/revisions\/28357"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=28317"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=28317"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}