Gastrointestinal Disorders

Hernias

Groin hernias — These fall into two categories: inguinal and femoral hernias. Inguinal hernias are further divided into either direct or indirect hernias.

Primary ventral hernias — Primary ventral hernias include epigastric, umbilical, and Spigelian hernias. Spigelian hernias are rare and will not be discussed in this chapter.

Ventral incisional hernias — Incisional hernias develop at the site of an incision from a previous abdominal procedure.

The LEO who has a hernia should have an evaluation for diagnosis and recommendations regarding the need for surgery.

Groin Hernias

Inguinal: Direct

Non-surgical treatment

The LEO who has had a recommendation for surgery, but has opted not to have surgery

• Asymptomatic – no restrictions are needed
• Aymptomatic – the police physician will need to determine if the hernia symptoms while performing essential job functions are severe enough to cause the LEO to be unable to perform full duty. If so, restrictions will be required.

The LEO who has been evaluated and has been determined not to need surgery

• Asymptomatic – no restrictions are needed
• Symptomatic – the police physician will need to determine if the hernia symptoms while performing essential job functions are severe enough to cause the LEO to be unable to perform full duty. If so, restrictions will be required.

Surgical treatment

Open or laparoscopic – The LEO status post-surgery who has shown successful return to training activities can typically return to unrestricted duty after 4-6 weeks post-surgery and after post-surgery surgical consultation.

Athletic Hernia (pubalgia) possibly a classification of direct hernia

Non-surgical treatment

LEO who has had a recommendation for surgery, but has opted not to have surgery:

• Asymptomatic (i.e., it has resolved) – no restrictions are needed
• Symptomatic – the police physician will need to determine if the hernia symptoms while performing essential job functions are severe enough to cause the LEO to be unable to perform full duty. If so, restrictions will be required.

LEO who has been evaluated and has been determined not to need surgery:

• Asymptomatic – no restrictions are needed
• Symptomatic – the police physician will need to determine if the hernia symptoms while performing essential job functions are severe enough to cause the LEO to be unable to perform full duty. If so, restrictions will be required.

Surgical Treatment

Open or laparoscopic – The LEO may return to unrestricted duty 4-6 weeks post-surgery and subsequent successful completion of training activities.

Inguinal: Indirect

Non-surgical treatment

LEO who has had a recommendation for surgery, but has opted not to have surgery:

• Asymptomatic – no restrictions are needed
• Symptomatic – the police physician will need to determine if the hernia symptoms while performing essential job functions are severe enough to cause the LEO to be unable to perform full duty. If so, restrictions will be required.

LEO who has been evaluated and has been determined not to need surgery:

• Asymptomatic – no restrictions are needed
• Symptomatic – the police physician will need to determine if the hernia symptoms while performing essential job functions are severe enough to cause the LEO to be unable to perform full duty. If so, restrictions will be required.

Surgical Treatment

Open or laparoscopic – The LEO may return to unrestricted duty 4-6 weeks post-surgery and subsequent successful completion of training activities.

Femoral

• This type of hernia has a high risk of incarceration and/or strangulation (see Appendix A) and is therefore usually managed with prophylactic surgery.
• Non-surgical treatment

LEO who has had a recommendation for surgery, but has opted not to have surgery:

• Asymptomatic – no restrictions are needed
• Symptomatic – the police physician will need to determine if the hernia symptoms while performing essential job functions are severe enough to cause the LEO to be unable to perform full duty. If so, restrictions will be required.

LEO who has been evaluated and has been determined not to need surgery:

• Asymptomatic – no restrictions are needed
• Symptomatic – the police physician will need to determine if the hernia symptoms while performing essential job functions are severe enough to cause the LEO to be unable to perform full duty. If so, restrictions will be required.

Surgical treatment

Open or laparoscopic – The LEO may return to unrestricted duty 4-6 weeks post-surgery and subsequent successful completion of training activities.

Ventral Hernias

Primary

Epigastric — These are usually managed non-surgically and do not require restrictions. If there are symptoms that prevent the performance of full duty, surgical referral and restrictions will be needed. The LEO may return to unrestricted duty 4-6 weeks post-surgery and subsequent successful completion of training activities.

Umbilical — These are usually managed non-surgically and do not require restrictions. If there are symptoms that prevent the performance of full duty, surgical referral and restrictions will be needed. The LEO may return to unrestricted duty 4-6 weeks post-surgery and subsequent successful completion of training activities.

Spigelian — Rare and not discussed in this chapter.

Incisional

These are usually managed non-surgically and do not require restrictions. If there are symptoms that prevent the performance of full duty, surgical referral and restrictions will be needed. The LEO may return to unrestricted duty 4-6 weeks post-surgery and subsequent successful completion of training activities.

Job Task Simulation Test

A job task simulation test may be needed to determine if the hernia symptoms, while performing essential job functions, are severe enough to cause the LEO to be unable to perform full duty. The following tasks may be used as part of the job task simulation test especially while wearing a duty belt:

• Defensive tactics training
• Running
• Squatting
• Jumping
• Lifting heavy objects

Ongoing Monitoring

• The police physician should evaluate the LEO to determine stability of the hernia and/or development of symptoms.
• If the size and symptoms have remained unchanged for 3 months, watchful waiting is an option.
• If size or symptoms have changed, the LEO should be referred for surgical evaluation.
• Restrictions should be considered for those who have worsening symptoms such as self-limiting of activities until evaluation by surgeon.

LEOs with hernias that have been evaluated and determined not to require surgical repair and who can satisfactorily perform the job task simulation test should not be restricted from full duty.