When should I consider referring a patient with a groin hernia for surgical evaluation?

Consider referring a patient with a groin hernia for surgical evaluation in the following situations:

• If the hernia is suspected to have a serious complication such as strangulation or intestinal obstruction, arrange emergency hospital admission immediately.
• For children and young people under 18 years, arrange an urgent referral to a paediatric surgeon, preferably to be seen within 2 weeks, due to higher risk of incarceration especially in infants and premature children.
• For adults (18 years and older), arrange urgent referral to general surgery if the hernia is irreducible or only partially reducible.
• Offer routine referral to general surgery if the hernia is symptomatic but reducible, based on clinical judgement.
• Referral may not be necessary if the hernia is minimally symptomatic and the patient has significant comorbidities or declines surgery.
• Asymptomatic or minimally symptomatic hernias can be managed with watchful waiting, but patients should be informed that surgery may be needed in the future.

These recommendations are based on expert opinion and guidelines from the Royal College of Surgeons, the British Association of Paediatric Surgeons, and the European Hernia Society.